Oral
Answers to
Questions

INTERNATIONAL DEVELOPMENT

The Secretary of State was asked—

Tajikistan

Nigel Mills: What recent assessment she has made of the effectiveness of her Department’s work in Tajikistan.

Priti Patel: UK development assistance has helped to reduce poverty and promote stability in Tajikistan since 2002. Between 2011 and 2016, DFID’s work has improved rural lives, promoted women’s economic empowerment, and delivered an important investment climate and managed public financial reforms.

Nigel Mills: I am grateful for that information. During a recent visit to Tajikistan I saw the good work that DFID had been doing, but many people have expressed concern about the fact that certain projects have been quite slow to be approved. Will my right hon. Friend update the House on the Department’s commitment to Tajikistan, and on when those projects might be signed off?

Priti Patel: I thank my hon. Friend, both for his question and for going to see DFID’s work in-country. The Minister of State, my hon. Friend the Member for Penrith and The Border (Rory Stewart), is overseeing new international development programmes, details of which will be published in due course.
Central Asia, including Tajikistan, represents an important strategic imperative in terms of our wider development objectives. We are, of course, committed to ensuring that commitments are implemented, and that we start to deliver on those programmes later in the year.

Kerry McCarthy: Tajikistan is very much at risk from climate change, which could threaten all the good work that is being done to improve livelihoods and economic development. Is dealing with that an element of DFID’s programme?

Priti Patel: As the hon. Lady will know, a variety of challenges exist in this part of central Asia. Dealing with climate change is one, but others are economic security, financial management and performance issues. DFID’s combined approach will help to deliver greater economic security in the long run.

Occupied Palestinian Territories

Louise Haigh: What assessment she has made of the implications of demolitions in the occupied Palestinian territories in 2015-16 for her Department’s policies in that region.

Simon Danczuk: What assessment she has made of the implications of demolitions in the Occupied Palestinian Territories in 2015-16 for her Department’s policies in that region.

Rory Stewart: The Department’s assessment, in line with long-standing British Government policy, is that demolitions are illegal under international humanitarian law, and that they undermine the credibility and viability of a two-state solution.

Louise Haigh: The Bedouin village of Umm-al-Hiran remains under threat from a demolition that would cast out 800 villagers, and the number of demolitions in the occupied territories in the first two weeks of January is almost four times greater than the number at this point last year. What support is being given to the people who are being driven out of their homes, and what message is being sent to the Israeli Government that such demolitions are completely unjustifiable?

Rory Stewart: The hon. Lady raises two important issues, the first of which is long standing. Along with our international partners, we continue to lobby the Israeli Government, who are undertaking the demolitions, to stop doing so, both because they are illegal and because they undermine the two-state solution.
The Under-Secretary of State for Foreign and Commonwealth Affairs, my hon. Friend the Member for Bournemouth East (Mr Ellwood), had a meeting with the Israeli Defence Minister, Mr Lieberman, just before Christmas, and raised the issue of demolitions with him directly.

Simon Danczuk: Will the Minister ensure that human rights non-governmental organisations operating on the west bank continue to receive support from the British Government?

Rory Stewart: We are absolutely focused on supporting NGOs, but above all we are focused on investment in health and education. It is getting the natural capital right, and providing opportunities and hope for the Palestinians, that will lead to security and stability for both sides in the conflict.

Mark Pawsey: Many of the demolitions occur because it is virtually impossible for Palestinians to obtain building permits. What legal support can the Department give to those who are contesting the process?

Rory Stewart: As I have said, DFID is focusing on health and education, but the Foreign Office has legal support programmes. This issue goes to the heart of the Israeli planning system, and involves controversies with the Israeli Attorney General. As my hon. Friend says, it  is very difficult to obtain planning permission, which is one of the reasons why settlements are built and demolitions then take place.

Tommy Sheppard: Among the buildings that the Israeli authorities have demolished are community facilities, some of which have been funded and developed with money from the Minister’s Department. I would welcome his statement, but I think that we need action rather than words. Has the time not come to send Mr Netanyahu the bill for the demolition of structures funded by the British taxpayer?

Rory Stewart: The British taxpayer has not funded any structures that have been demolished by the Israeli Government. The European Union has funded structures that have been demolished by the Israeli Government, but so far it has not decided to seek compensation.[Official Report, 8 February 2017, Vol. 621, c. 2MC.]Rory

Tom Brake: Will the Minister confirm that DFID, notwithstanding the efforts of a senior Israeli diplomat to “take down” a Minister, will continue to fight against collective punishment, demolitions in the OPTs and the expansion of the illegal settlements?

Rory Stewart: We are conflating two different issues here. As the Foreign Secretary said yesterday, the Israeli ambassador has already apologised for that incident, and the diplomat concerned has been removed from his post and sent home. I think I have dealt with the overall questions of settlements and demolitions in my answers to the other questions.

Kate Osamor: I thank the Minister for his responses, but I would like him to be a bit clearer and tell us how DFID has supported those people who are now homeless due to the systematic policy of settlement expansion.

Rory Stewart: The central story is that DFID is doing three types of things for Palestinian people. First, we are supporting Palestinian state structures, in particular health and education—doctors, teachers and nurses. Secondly, we are working on making sure that we can create a viable economy and employment, particularly through support to small businesses. Thirdly, we invest in human capital; in other words, we invest in making sure that the Palestinian people are educated, healthy and have opportunities for security and stability in the region in the short term. But in the long term there cannot be a two-state solution unless we address the needs of the Palestinian people.

Aleppo

Craig Williams: What steps the Government are taking to support people in Aleppo.

Priti Patel: What has happened in Aleppo is a tragedy and underlines the regime’s callous tactics of siege, starvation and indiscriminate bombardment. Through the UK’s humanitarian leadership and diplomatic efforts, we are doing all we can do to support the protection of civilians and, importantly, ensure that they receive the aid they so desperately need.

Craig Williams: I thank the Secretary of State for that answer. The UK committed £510 million in support at the London Syria conference in February last year. Is she on course to hit that target?

Priti Patel: I thank my hon. Friend for his question on this important issue, which gives me the chance to restate to the House the British Government’s commitment to, and long-standing support for, Syria. We have surpassed that pledge of £510 million made at the Syria conference last year. It is fair to say not only that the UK can be proud of its support, but that we have ensured that there is the right support in terms of humanitarian supplies and the focus for the region, while at the same time using our international convening power to work with others globally to ensure that we do everything we possibly can to support Syria and the region.

Stephen Twigg: At the world humanitarian summit in Istanbul last year the United Kingdom committed to the centrality of protection as a fundamental principle. How has that guided DFID’s approach to the situation in Aleppo, and what lessons will we learn from the tragedy of Aleppo for future civilian protection?

Priti Patel: The hon. Gentleman makes an important point in relation to the conference last year and how the humanitarian community can come together and not just learn lessons, but understand ways of working in times of severe crisis and of conflict. There are a number of lessons we can learn, including on agencies working together, the pooling of resources, and making sure that Governments across the world are working together strategically in terms of both resource allocation and, importantly, our convening power—the leverage we all have collectively in the international space to challenge Governments where they are inflicting harm and causing grief and devastation, and to make sure that we stand shoulder to shoulder and are united in how we tackle the challenge.

Victoria Prentis: People give to Singing for Syrians because they know that 100% of the money they donate will be spent on prosthetic limbs and medical salaries in the region, as close to Aleppo as we can get it. What more can the Secretary of State do to ensure that DFID money is spent in the region and not wasted on advocacy and lobbying in  the UK?

Priti Patel: First, I commend my hon. Friend on her work on, and leadership in, Singing for Syrians; it is an incredible organisation and has been very successful in raising important funds. On making sure that the money is not wasted and goes directly into the region and in-country, we not only support, fund and collaborate with trusted partners, but, importantly, measure the outcomes that we are delivering in these essential humanitarian policies.

Alison McGovern: The Secretary of State is already talking about Aleppo in the past tense, but the besiegement is still happening right now, and the British Government must do more. What representations has she made to the Foreign Secretary about putting in place more and harder sanctions  on Russia?

Priti Patel: The hon. Lady is absolutely right. The situation not only in Aleppo but in Syria full stop is beyond comprehension. She asks about representations. The Foreign Secretary and I work hand in hand on international issues, and the Government are calling for greater collaboration on access to humanitarian routes into besieged areas. This is not a case of one Department versus another; it is the voice of the British Government working together to make public representations and representations behind the scenes.

Caroline Spelman: Before the war, Aleppo had Syria’s largest population of Christians. Now it is estimated that 90% of them have fled. In Parliament today, Open Doors will launch its World Watch List, which shows that religious persecution is one of the key drivers of migration. What can my right hon. Friend’s Department do to help the poor, persecuted Christians of Aleppo?

Priti Patel: My right hon. Friend is absolutely right to highlight the plight of persecuted Christians, especially in the context of Aleppo and Syria. She asks what we can do. This is not just a matter for DFID; the whole Government must speak out on the issue and constantly make it clear that the persecution of minorities and religious groups is totally unacceptable. That is the right thing to do. We also need to make that case within the international community and work collaboratively with donor countries and other countries across the world.

Patrick Grady: Following the announcement during the Christmas recess that DFID would be piloting the use of drones to deliver medical supplies in Tanzania and to map weather damage in Nepal, what discussions has the Secretary of State had with Ministers in the Ministry of Defence about how drone technology could be used to deliver aid or assess humanitarian need in Aleppo and other parts of Syria?

Priti Patel: The hon. Gentleman is right to highlight the fact that we have been innovating and looking at new technology in relation to aid provision via drones. A lot of work is taking place in that space, and we have had a number of debates in the House about other ways of delivering humanitarian assistance, particularly in besieged areas. In the specific context of besieged areas in Syria, work is taking place and there have been discussions. I can assure the House that we are actively pursuing this issue, not just in DFID but across the Government.

James Gray: The Secretary of State’s heart is very much in the right place, as we all know, but the fact is that the greatest humanitarian catastrophe of modern times is taking place in Aleppo, Raqqa and Mosul today. In contrast to the warm words that we have heard in the exchanges of the past few minutes, should we not now admit that there is precious little that we in the liberal west can do to alleviate the appalling circumstances in Aleppo unless we have the support of the United Nations and Russia?

Priti Patel: My hon. Friend makes an important point. In terms of the work that the Government are doing, we must never lose sight of the fact that we are  leading in humanitarian assistance and support. People are in desperate need, and we have the right focus on giving them all the necessary support. The other point is diplomacy. It is the job of the Government to carry on putting on the pressure, and we must use all the avenues of international diplomacy to put that pressure on, where it is needed.

Kate Osamor: I should like to focus on Idlib in north-western Syria, where civilians who have fled Aleppo are the main target of Government strikes. Will the Secretary of State tell the House how DFID is supporting those wounded and displaced civilians?

Priti Patel: I thank the hon. Lady for her focus on the humanitarian issue in Syria, which is of course associated with Idlib as well. She asks about the work that is taking place. There are extensive humanitarian efforts in terms of relief, food and shelter in what is a desperate situation. As she and the whole House will know, I have spent a great deal of time working with all the agencies that we are directly supporting and funding to ensure that supplies are getting through, and they are. I would add the caveat that this is taking place in a challenging environment and climate. We are getting supplies through, but it is increasingly difficult to do so.

Energy Access: Africa

Steve Double: What steps her Department is taking to improve energy access in Africa.

James Wharton: Access to energy is a prerequisite driver of economic growth and development. Over 620 million people in sub-Saharan Africa have no access to energy. When able to secure it, the world’s poorest people can pay up to 80 times what we pay. That is why the UK and this Department are playing a key role in providing both on and off-grid energy access, such as through the Energy Africa campaign, which will help to secure energy supplies for over 4.5 million of the world’s poorest people.

Steve Double: I know from my visits to east Africa that providing access to reliable, sustainable, clean energy is crucial for economic growth and prosperity in Africa. Does the Minister agree that the CDC and its investment in Africa present one of the best opportunities to provide that?

James Wharton: I absolutely agree that the CDC can play a key role. I am pleased that the House showed support for its work only yesterday in a debate led by the Minister of State, my hon. Friend the Member for Penrith and The Border (Rory Stewart), with support from the Secretary of State. A good example is Globeleq, in which the CDC has a majority stake, which will drive forward energy provision of 5,000 MW in Africa—1,000 MW can support 800,000 jobs. That is the scale of the difference we can make when and where we get this right, and that is why we are doing it.

Carol Monaghan: The German Government have called on the World Bank to focus all its work on climate and sustainability  targets and to put an end to investments in obsolete, climate-damaging technologies. Given that the World Bank is the largest recipient of UK aid for energy, will the Government follow Germany’s example and use their influence to call on the World Bank to stop investing in fossil fuels?

James Wharton: I have set out some of the reasons why energy supply is so important in driving development. Of course, it is also important that that supply is sustainable and environmentally friendly. In all the projects that DFID pursues, we seek to ensure that that is the case, including in our discussions with the World Bank. Given our contributions and their impact, we recognise that it is particularly important that the World Bank appreciates and works towards that agenda.

Middle-income Countries: Aid Withdrawal

Mike Freer: What measures her Department plans to put in place to ensure that marginalised groups in middle-income countries are supported in the event of aid from her Department being withdrawn from those countries.

James Wharton: Programme sustainability is crucial, and all DFID programmes are designed with long-term sustainability and impact in mind. No decisions have been made to exit countries in the context of my hon. Friend’s question. When and where that happens, we want to ensure that a positive legacy is left and that the “leave no one behind” agenda is adhered to, so that some of the poorest and most vulnerable people in the world receive the protection and support that they ought to be able to expect.

Mike Freer: The American Government operate the Global Equality Fund to ensure that marginalised groups are not left behind. Will my hon. Friend consider whether the UK should initiate a similar fund?

James Wharton: My hon. Friend is absolutely right. Marginalised groups, particularly in countries that are not the poorest, are sometimes the most vulnerable. We rightly focus our efforts and attention on the world’s poorest countries with the largest number of people in greatest need of support, but other groups elsewhere also need support. We must always be aware of that and ensure that our programmes have a sustainable impact. I will be delighted to have further discussions with my hon. Friend about his idea.

Douglas Chapman: The Independent Commission on Aid Impact concluded in a recent report that there is

James Wharton: The Department will always consider what we need to do to ensure sustainable and long-lasting transition, and programmes must be designed in that way. That is a common thread that runs through every programme that DFID supports and every decision  that Ministers make. We will continue to work in this area and are happy to consider further proposals for what might improve the quality of the work that is done.

Topical Questions

Graham Evans: If she will make a statement on her departmental responsibilities.

Priti Patel: Whether by giving to Syrian refugees, providing access to food or clean water, or creating jobs across Africa, UK aid helps us to meet our obligations to the world’s poorest. Such investment is also firmly in Britain’s national interest because it tackles the root causes of global problems while focusing on delivering world-class programmes that deliver value for money for UK taxpayers.

Graham Evans: The Secretary of State has previously said that she is looking at allocating DFID funding to peaceful co-existence projects, including Save a Child’s Heart, whose valuable work brings Palestinians and Israelis together. Can she update the House on that very worthy project?

Priti Patel: I am pleased to confirm that we are indeed working on a range of co-existence programmes in Israel and the Occupied Palestinian Territories to support tangible improvements, as my hon. Friend the Minister of State has said. The programme is now in its final design phase and will be launched at the beginning of the financial year. [Interruption.]

John Bercow: Order. I understand the air of anticipation in the Chamber just before Prime Minister’s questions, but I remind the House that we are discussing matters that affect the poorest people on the face of the planet. They should be treated with respect.

Imran Hussain: The protection of civilians in Aleppo must remain our absolute priority, but if we are to provide food, water, shelter and humanitarian relief to civilians who, for four years, have faced the horrors of an inhumane war, we need to ensure that the ceasefire, although currently holding, remains more than a brief pause. Can the Secretary of State therefore say what efforts the Government are making to ensure that conflict does not reignite in Aleppo? What contingency plan does DFID have in place to continue providing aid to civilians should the conflict reignite? We must not see humanity in meltdown again.

Priti Patel: The hon. Gentleman is right that the UK will do everything it possibly can to support the current ceasefire and, importantly, to safeguard humanitarian support in the region, too. That is down to our diplomatic tools and diplomatic efforts but, importantly, we are also making sure that all agencies work together to deliver the vital humanitarian support that is required.

Philip Davies: No self-respecting Conservative believes that we should be judged simply on how much we spend on something. Spending a guaranteed amount of money each year on overseas  aid leads to waste and excess such as the £1 billion spent each year on consultants. When can we get back to some common sense and stop spending more and more on overseas aid every year when the money could be much better spent at home?

Priti Patel: Like all Conservatives, I, too, want to focus on making sure that every penny of taxpayers’ money goes to helping the world’s poorest, which is exactly the mission of our Department. At the same time, my hon. Friend will know that overseas development assistance saves lives and transforms lives. He specifically refers to money spent on consultants, which is something that my Department is currently reviewing. [Interruption.]

John Bercow: Order. The Secretary of State’s replies must be heard with courtesy. It is rather alarming when some of her own Back Benchers are not according her the proper respect. She must be accorded the proper respect.

Danny Kinahan: We receive much lobbying on the Israeli and Palestinian need for delivery on the ground, but what is the Minister of State’s assessment of the effect of terrorism and how difficult it makes it to deliver on the ground to those in real need, whether it is education or humanitarian aid?

Rory Stewart: The hon. Gentleman makes a fundamental point. We have talked a great deal about demolitions and settlements, but the only long-term stability in that region requires protecting the security of Israel as an absolutely essential plank, along with guaranteeing an autonomous, independent Palestinian state.

Christopher Chope: The most sustainable aid is aid through trade. Will the Secretary of State therefore ensure that, when we leave the European Union and the customs union, we give top priority and free access to our markets to exports from the poorest countries?

Priti Patel: My hon. Friend will know that our priority is, of course, economic development and making sure that, through our aid, we are delivering long-term sustainable economic development and prosperity in everything we do. He is also right to note that DFID is working across Government as we leave the European Union to look at unilateral trade preferences and the work we can do to grow our trade footprint across the world.

Deidre Brock: Unlike the hon. Member for Shipley (Philip Davies), we in the Scottish National party welcome the fact that OECD data show that, last year, the UK was one of only six countries to meet the 0.7% aid target. That, of course, includes the Scottish Government’s international aid fund. What assurances can the Secretary of State give that her Government’s commitment to that target is unwavering and will continue to be fulfilled beyond the next general election?

Priti Patel: We have been unequivocal in our commitment to 0.7% and, in addition, it is a manifesto commitment. Let me restate again, for the benefit of the House, that the focus of my Department is on poverty reduction  and on ensuring that that money is spent to drive taxpayer value and deliver programmes for the poorest in the world.

John Bercow: I call Pauline Latham. The hon. Lady wanted to ask a question earlier. Is she no longer inclined to do so?

Pauline Latham: I am here. Thank you very much, Mr Speaker. The Select Committee visited the Democratic Republic of the Congo last year and saw the amazing work done by the CDC, which is creating not only more energy for millions of people, but a lot of jobs. May we encourage the CDC to do even more schemes like that?

Rory Stewart: I thank my hon. Friend very much for paying tribute to the incredibly important role of the CDC. By bringing the rigour of the private sector with the genuine values of the public sector, we have demonstrated in DRC the ability to provide hydro power that benefits thousands of people. I also wish to pay testament to the Chair of the International Development Committee for his tribute to that project in particular.

Ian Austin: Will the Secretary of State reconsider her Department’s decision to cut every single penny of spending on co-existence projects, which bring the Israelis and Palestinians together, and lay the foundations for a peace process and two-state solution?

Priti Patel: I thank the hon. Gentleman for his question. He will have heard in the previous responses our commitment to co-existence programmes, and about how they will not just drive the right values, but help to bring the two communities together in a very constructive way—this is in addition to our focus on targeted spending on public schemes such as health and education programmes within the region.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Chris Law: If she will list her official engagements for Wednesday 11 January.

Theresa May: This morning, I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.

Chris Law: A very happy new year to you, Mr Speaker, and I would like to extend that to everyone in this House.
It has been more than six months since the European referendum. Embarrassingly for the Prime Minister, the Scottish Government are the only Administration on these islands to have published a plan on what to do next. Has she read it yet? When will she be publishing her own plan?

Theresa May: I join the hon. Gentleman in wishing everybody in the House, not only Members, but all the staff of the House, a very happy new year.
As I said to the Liaison Committee when I appeared in front of it before Christmas, I will, in a matter of weeks, be setting out some more details of our proposals on this issue. I would like just to remind him, when he talks about the Scottish Government’s plan, that of course it is his party, the Scottish nationalist party, that wants to leave the United Kingdom and therefore leave the European Union.

Mark Menzies: Westinghouse’s Springfields site in my constituency employs more than 1,200 people in highly skilled jobs manufacturing nuclear fuel, which generates 15% of the UK’s electricity. Does my right hon. Friend agree that the nuclear industry is of crucial importance to the north-west economy? Will she continue to support the construction of a new generation of nuclear power stations to guarantee jobs in the region?

Theresa May: I certainly agree with my hon. Friend that new nuclear does have a crucial role to play in securing our future energy needs, especially as we are looking to move to a low-carbon society. The industrial strategy that the Government will be setting out will have a strong emphasis on the role of regions in supporting economic growth and ensuring that the economy works for everyone. Like him, I very much welcome the proposals from NuGen and Toshiba to develop a new nuclear power station at Moorside in Cumbria. The Department for Business, Energy and Industrial Strategy continues to work closely with NuGen and other developers as they bring their proposals forward.

John Bercow: I call Jeremy Corbyn. [Hon. Members: “Hear, hear!”]

Jeremy Corbyn: Thank you, Mr Speaker. It is nice to get such a warm welcome, and may I wish all Members, as well as all members of staff in the House, a happy new year?
I hope the whole House will join me—I am sure it will—in paying tribute to 22- year-old Lance Corporal Scott Hetherington, who died in a “non-combat” incident in Iraq last Monday. I am sure the whole House will also join in sending its heartfelt condolences to the family and friends of seven-year-old Katie Rough, who tragically died in York earlier this week. I think it is right that we send condolences to her family.
Last week, 485 people in England spent more than 12 hours on trolleys in hospital corridors. The Red Cross described this as a “humanitarian crisis”. I called on the Prime Minister to come to Parliament on Monday, but she did not—she sent the Health Secretary. But does she agree with him that the best way to solve the crisis of the four-hour wait is to fiddle the figures so that people are not seen to be waiting so long on trolleys in NHS hospitals?

Theresa May: First, may I join the right hon. Gentleman in sending our condolences to the family of Lance Corporal Hetherington, who, as he said, died in a non-combat incident in Iraq? From everything I have seen and read about Lance Corporal Hetherington, he  was a very fine young man. He delighted in being in the armed forces, and we are proud that such a fine young man was in our armed forces. I also join the right hon. Gentleman in expressing condolences to the family and friends of little Katie, who died so tragically.
The right hon. Gentleman talks about the pressures on the NHS, and we acknowledge that there are pressures on the National Health Service. There are always extra pressures on the NHS during the winter but, of course, we have at the moment those added pressures of the ageing population and the growing complex needs of the population. He also refers to the British Red Cross’s term, “humanitarian crisis.” I have to say to him that I think we have all seen humanitarian crises around the world, and to use that description of a National Health Service that last year saw 2.5 million more people treated in accident and emergency than six years ago was irresponsible and overblown.

Jeremy Corbyn: Some 1.8 million people had to wait longer than four hours in A&E departments last year. The Prime Minister might not like what the Red Cross said, but on the same day the British Medical Association said that
“conditions in hospitals across the country are reaching a dangerous level.”
The Royal College of Nursing has said that NHS conditions are the worst ever. The Royal College of Physicians has told the Prime Minister that the NHS is
“under-funded, under-doctored and overstretched.”
If she will not listen to the Red Cross, who will she listen to?

Theresa May: I have said to the right hon. Gentleman that I of course acknowledge that there are pressures on the National Health Service. The Government have put extra funding into the National Health Service. The fact is that we are seeing more people being treated in our NHS: 2,500 more people are treated within four hours every day in the National Health Service because of the Government putting in extra funding and because of the hard work of medical professionals in our National Health Service. It is not just a question of targets for the health service, although we continue to have a commitment to the four-hour target, as the Health Secretary has made clear. It is a question of making sure that people are provided with the appropriate care for them, and the best possible care for them in their circumstances.

Jeremy Corbyn: The right hon. Lady seems to be in some degree of denial about this. She will not listen to professional organisations that have spent their whole lifetimes doing their best for the NHS, but will she listen to Sian, who works for the NHS? She has a 22-month old nephew. He went into hospital, but there was no bed. He was treated on two plastic chairs pushed together with a blanket. Sian says that
“one of the nurses told my sister that it’s always like this nowadays”.
She says to us all:
“Surely we should strive to do better than this.”
Do the Prime Minister and the Health Secretary think that is an acceptable way to treat a 22-month-old child in need of help?

Theresa May: I accept that there have been a small number of incidents in which unacceptable practices have taken place. We do not want those things to happen, but what matters is how you deal with them, which is why it is so important that the NHS looks into the issues when unacceptable incidents have taken place and learns lessons from them. I come back to the point that I was making earlier: the right hon. Gentleman talks about the hard-working healthcare professionals, like Sian, in the National Health Service, and indeed we should be grateful for all those who are working in the NHS, but on the Tuesday after Christmas we saw the busiest day ever in the National Health Service, and over the few weeks around Christmas we saw the day on which more people were treated in accident and emergency within four hours than ever before. That is the reality of our National Health Service.

Jeremy Corbyn: We all thank NHS staff and we all praise NHS staff, but the Prime Minister’s Government are proposing, through sustainability and transformation, to cut one third of the beds in all of our hospitals in the very near future. On Monday, she spoke about mental health and doing more to help people, particularly young people, with those conditions, which I welcome, except that last night the BBC revealed that, over five years, there had been an 89% increase in young people with mental health issues having to go to A&E departments. Does she not agree that the £1.25 billion committed to child and adolescent mental health in 2015 should have been ring-fenced rather than used as a resource to be raided to plug other holes in other budgets in the NHS?

Theresa May: If we look at what is happening with mental health treatment in the national health service, we see 1,400 more people every day accessing mental health services. When I spoke about this issue on Monday, I said that there is of course more for us to do—this is not a problem that will be resolved overnight. I have set out ways in which we will see an improvement in the services in relation to mental health, but it is about the appropriate care for the individual. As I mentioned earlier, that is not just about accident and emergency. When I was in Aldershot on Monday, I spoke to service users with mental health problems who said that they did not want to go to A&E. The provision of alternative services has meant that the A&E locally has seen its numbers stabilising rather than going up. It is about the appropriate care for the individual. We want to see that good practice spread across the whole country.

Jeremy Corbyn: Nobody wants people with mental health conditions to go to A&E departments—the A&E departments do not want them to go there. Under this Government, there are 6,000 fewer nurses and 400 fewer doctors working in mental health. It is obvious that these people will go somewhere to try to get help when they are in a desperate situation. Our NHS is under huge pressure. Much of that is caused by cuts to social care, which the Royal College of Physicians says
“are pushing more people into our hospitals and trapping them there for longer.”
Will the Prime Minister do what my hon. Friend the Member for Leicester South (Jonathan Ashworth) has called for and bring forward now the extra £700 million allocated in 2019 and put it into social care so that we  do not have this problem of people staying too long in hospital when they should be cared for by a social care system?

Theresa May: The right hon. Gentleman asked me those questions in the last PMQs before Christmas. [Interruption.] He may find it difficult to believe that somebody will say the same thing that they said a few weeks ago, but we have put extra money into social care. In the medium term, we are ensuring that best practice is spread across the country. He talks about delayed discharges. Some local authorities, which work with their health service locally, have virtually no delayed discharges. Some 50%—half of the delayed discharges—are in only 24 local authority areas. What does that tell us? It tells us that it is about not just funding, but best practice. If he comes back to me and talks to me about funding again, he should think on this: we can only fund social care and the NHS if we have a strong economy, and we will only have that with the Conservatives.

Jeremy Corbyn: I am sorry to have to bring the Prime Minister back to the subject of social care, which I raised before Christmas. The reason I did so, and will continue to do so, is that she has not addressed the problem. The Government have cut £4.6 billion from the social care budget. The King’s Fund says that there is a social care funding gap of almost £2 billion this year.
Earlier this week, the Prime Minister said that she wanted to create a “shared society”. Well, we certainly have that: more people sharing hospital corridors on trolleys; more people sharing waiting areas in A&E departments; and more people sharing in the anxiety created by this Government. Our NHS is in crisis, but the Prime Minister is in denial. May I suggest to her that, on the economic question, she should cancel the corporate tax cuts, and spend the money where it is needed—on people in desperate need in social care and in our hospitals?

Theresa May: The right hon. Gentleman talks about a crisis. I suggest he listens to the right hon. Member for Don Valley (Caroline Flint), a former Labour Health Minister, who said that, with Labour,
“It’s always about ‘crisis...the NHS is on its knees’… We’ve got to be a bit more grown up about this.”
And he talks to me about restoring the cuts in corporation tax. The Labour party has already spent that money eight times. The last thing the NHS needs is a cheque from Labour that bounces. The only way that we can ensure that we have funding for the national health service is with a strong economy. Yesterday, the right hon. Gentleman proved that he is not only incompetent, but that he would destroy our economy, and that would devastate our national health service.

Maria Miller: Cyber-bullying, sexting and revenge pornography are part of British teenage life today; so is a rapid increase in mental health problems among our teenagers. How is the Prime Minister helping to tackle the pressures that teenagers face in Britain today?

Theresa May: My right hon. Friend raises an important point. One of the things I spoke about, when I spoke about mental health on Monday, was trying to ensure that we can provide some better training for staff  and teachers in schools to identify the early stages of mental health problems for young people, so that those problems can be addressed. Something like half of all mental health problems start before the age of 14, so this is a real issue that we need to address. We are going to look at how we can provide that training. We will also review the mental health services provided for young people to ensure that we can identify what is working and make sure that good practice is spread across the country.

Angus Robertson: May I begin with a tribute to Father George Thompson, who died shortly before Christmas? He led a remarkable life as a teacher, as a priest and as the Scottish National party Member of Parliament for Galloway. We extend our sympathies to his family.
All of us in this House and across these islands care about the peace process and about the democratic institutions in Northern Ireland, so may I wish the Prime Minister well and the Taoiseach, the Northern Ireland Secretary and the political parties all the best in trying to resolve the serious political difficulties there? Will the Prime Minister tell us what the consequences will be if no agreement can be found?

Theresa May: First, may I join the right hon. Gentleman in offering condolences to the family and friends of the Rev. George Thompson, who, as he says, was the MP for Galloway between 1974 and 1979 and, I believe, was the first former MP in modern times to be ordained a Roman Catholic priest.
On the issue that the right hon. Gentleman raises about the political situation in Northern Ireland, we are obviously treating this with the utmost seriousness. As he will know, my right hon. Friend the Northern Ireland Secretary made a statement in the House earlier this week on this issue. He has spoken to the First Minister and the former Deputy First Minister, and he is urging all parties to work together to find a way forward. I have also spoken to the Taoiseach about this issue, so we are putting every effort into this. The legislation says that if, within seven days, we do not have a nomination for a Deputy First Minister, the matter would go to an election.

Angus Robertson: The Prime Minister has indicated that she wants to take the views of the elected representatives and the devolved institutions on Brexit seriously. So it stands to reason then that if there is no Northern Ireland Assembly and no Northern Ireland Executive for much of the time before the March timetable that she has set for invoking article 50, she will be unable to consult properly, to discuss fully and to find agreement on the complex issues during this period. In these circumstances, will the Prime Minister postpone invoking article 50—[Interruption]—or will she just plough on regardless?

Theresa May: As the right hon. Gentleman says, we want to ensure that we do hear the views from all parts of the United Kingdom. That is why we have established the JMC European committee specifically to take views, and the JMC plenary, which is also obviously meeting more frequently than previously. I am clear that, first of all, we want to try to ensure that,  within this period of seven days, we can find a resolution to the political situation in Northern Ireland, so that we can to see the Assembly Government continuing. But I am also clear that, in the discussions that we have, it will be possible—it is still the case that Ministers are in place and that, obviously, there are executives in place—that we are still able to take the views of the Northern Ireland people.

Economy/Public Services (Staffordshire)

Michael Fabricant: What recent assessment she has made of the (a) performance of the economy and (b) adequacy of provision of public services in Staffordshire; and if she will make a statement.

Theresa May: The fundamentals of the UK’s economy are strong, including in Staffordshire and the west midlands. Employment in Staffordshire has risen by over 20,000 since 2010. We have protected schools and police budgets. We see more doctors and more nurses in the Burton hospitals trust. Of course, we are going further than this in the west midlands by giving new powers to the west midlands with the devolution deal and with the election of a directly elected Mayor. I have to say that I think Andy Street, with his business and local experience, would be a very good Mayor for the west midlands.

Michael Fabricant: I thank my right hon. Friend the Prime Minister for that answer. Unemployment in my constituency—my beautiful Lichfield constituency—is around 0.7%, and that is fantastic, but I want it even lower. I found out that 24% of my constituents work in the area of the West Midlands Combined Authority, so can I press my right hon. Friend just a little further about what she thinks is needed in the West Midlands Combined Authority to improve employment still more?

Theresa May: I thank my hon. Friend, and, of course, I have had the advantage of having visited his beautiful constituency. But in relation to the midlands, we have a very strong ambition to make the midlands an engine for growth in the UK. That is why we have plans for the midlands engine that demonstrate that, when we say we are going to build an economy that works for everyone, we actually mean it. In the autumn statement, my right hon. Friend the Chancellor confirmed things such as the £5 million for a Birmingham rail hub and a £250 million midlands engine investment fund, and we will shortly be publishing a strategy for the midlands engine. But I repeat the point that I made: for the west midlands, having the devolution deal, having the Mayor and having the right person elected as Mayor, who I think will be Andy Street, is absolutely crucial.

Engagements

Ian Murray: Happy new year, Mr Speaker. Sir Ivan Rogers, in his resignation letter, said that people may have to deliver messages to the Government that Ministers may find disagreeable. So here is a message that the Prime Minister may find disagreeable: her lack of priority for the single market is putting jobs in Scotland and the economy at risk. That means her Government are as  big a threat to the Union as the SNP. Her Government are not worthy of the trust of Scots, let alone their blind trust, so will the Prime Minister take this opportunity to apologise for threatening the Union and give a solemn promise to every single person in this country that they will not be a penny worse off after a Tory Brexit?

Theresa May: The hon. Gentleman will be very well aware that I want to see the best possible trade deal for the United Kingdom with the EU and the best possible deal for trading with and operating within the single European market. When we enter the negotiations, obviously, that is one of the issues that I have said that I want to see, and we will be out there and be delivering on it. Unlike the sort of downplaying that the hon. Gentleman does about the approach that we are taking, I have to say that it is this Government that is ambitious for the opportunities that are available to this country once we leave the European Union.

Antoinette Sandbach: Cheshire schools in areas of rurality and areas of high deprivation will receive some of the lowest per-pupil funding rates in the country under the new proposed funding formula. Does the Prime Minister agree that these discrepancies must be addressed to ensure that Eddisbury pupils get the best possible start in life?

Theresa May: I think everybody recognises that the way that schools have been funded in the past has been unfair and many pupils have been missing out. That is why I think it is right for us to look at bringing forward a new fair funding formula, making sure that funding is attached to children’s needs. Of course we recognise the particular issues of rural areas in this, and that is why, within the fair funding formula, additional funding for such schools has been included. But, of course, the Department for Education has this out for consultation at the moment, and I would urge my hon. Friend to make her representations as part of that consultation.

Tracy Brabin: Dewsbury hospital A&E is set for a downgrade this year. Over Christmas, I had constituents who were waiting 20 hours for a bed in a facility that might not even exist next year. Will the Prime Minister please face reality and act now to stop this vital A&E service from disappearing?

Theresa May: What the hon. Lady is referring to, of course, is the plans that are being put forward at local level to consider—[Interruption.]

John Bercow: Order. There is far too much noise. I must say to the hon. Member for Dewsbury (Paula Sherriff) that if she were behaving like this in another public place she would probably be subject to an antisocial behaviour order.

Theresa May: I return to the point, Mr Speaker. Decisions about services in the local area are rightly taken by the local national health service, because we believe that it is local clinicians, and also local patients and leaders, who know what is best for their areas. So it is about trying to tailor the services to provide the best possible services for the needs of local people, modernising the care and facilities, and making services appropriate  to the local area. This trust has an extensive improvement plan to ensure that both hospitals within it can care for patients attending accident and emergency in as timely a way as possible.

Richard Fuller: Next Thursday evening, I will host the first session of the Bedford community business school, free of charge and open to all, with 250 local people sharing a passion for entrepreneurship and learning tips about business from national and local business leaders. Will my right hon. Friend ensure that her forthcoming industrial strategy has at its heart the passion and the interest of Britain’s small business leaders and entrepreneurs?

Theresa May: I can absolutely give my hon. Friend that commitment. What is important is that the industrial strategy will be looking to the economy of the future—what sort of economy we want in this country. Crucial to that will be the growth that is generated by entrepreneurs and by small businesses—by the very passion that he has spoken about. We want to see an environment in which those who can grow can emerge and develop to provide future jobs for people and contribute to the strength of our economy. That is what the industrial strategy is about; I absolutely agree with my hon. Friend.

Norman Lamb: The Prime Minister, I am sure, will understand, despite the reassurances, that there are genuine and really serious concerns among staff across the NHS and the care system, and patients and their families, about the pressure that they are under. For that reason, MPs from her own party, from the Labour party and from my party have come together to call for the Government to establish an NHS and care convention to engage with the public, so that we can come up with a long-term settlement for the NHS and care. Would the Prime Minister be prepared to meet us to discuss it, so that she can hear our case?

Theresa May: I recognise, obviously, the interest and the attention that the right hon. Gentleman has given to these issues—of course, he is a former Health Minister—and I would be happy to meet him and others, as he suggests.

Edward Argar: There can be nothing as distressing for a parent as the death of their child, particularly where that child has been murdered. That is what happened to the two ladies, one of them a constituent of mine, who set up Justice After Acquittal, successfully campaigning for voluntary national standards of support by the Crown Prosecution Service and by the police for the families of murder victims following an acquittal. Those standards are due to be launched here next Tuesday. Will the Prime Minister join me in paying tribute to the determination and energy with which they have campaigned for their cause, and will she continue to ensure, as she always has done, that the voices of the victims of crime and their families are always listened to?

Theresa May: My hon. Friend raises a very important point. I am very happy to join him in paying tribute to these two campaigners. Indeed, I am sure that the whole House would want to pay tribute to the work  that they are doing. As he says, I remain committed to ensuring that the voices of victims are heard. That is what I did when I was Home Secretary, if we look at issues such as introducing new measures to tackle modern slavery, strengthening the Independent Police Complaints Commission and legislating in relation to police complaints and discipline systems to strengthen public confidence in policing, and a number of other actions that I took. I am very pleased to say that my right hon. Friend the current Home Secretary is taking that same passion to ensuring that the voices of the victims of crime are heard and is taking that forward.

Joanna Cherry: Across the United Kingdom, many banks are accelerating their closure of local branches, with adverse effects on vulnerable and older people and adverse effects on the high street. The Royal Bank of Scotland is closing down branches across Scotland, including those at Juniper Green and Chesser in my constituency. Local convenience stores are taking the strain of processing bills and often face exorbitant bank charges for the privilege of doing so. Will the Prime Minister meet me to discuss how we can realise a situation where banking across the UK services customers and the real economy?

Theresa May: The issue of bank branches and, indeed, of the accessibility of bank services is one that is for individual banks themselves to take and consider, and of course there are many ways in which people are now accessing bank services other than by going physically into an actual bank branch, but I will certainly look at the issue that the hon. and learned Lady has raised.

James Davies: Building a country that works for everyone means doing even more to tackle the economic and social deprivation that has come to afflict pockets of seaside towns such as Rhyl in my constituency. Will my right hon. Friend therefore support Growth Track 360, a locally developed plan to invest in rail infrastructure to help unlock the true potential of the north Wales and Mersey-Dee economic region as an integral part of the northern powerhouse, connected to the rest of the country via the proposed HS2 hub at Crewe?

Theresa May: I welcome the establishment of the north Wales and Mersey-Dee rail taskforce and  the work that it is doing. The plan that my hon.  Friend mentions sets out an ambitious programme of improvements for the area, and I am sure it will be prioritising the most promising options. I can say to him that the Department for Transport will continue to work closely with the taskforce and with the Welsh Government to consider what can be jointly accomplished.

Alan Brown: As Pensions Minister, Steve Webb misled the public about the value of the single-rate pension. He also gave us the Pensions Act 2011. He was rightly booted out by the voters, yet is now deemed suitable for a knighthood. Does the Prime Minister not understand that, unless this Government take action to help the struggling WASPI women, that knighthood will be the final insult to these women?

Theresa May: Action has been taken on the issue in relation to women’s pensions. The Government took action to ensure that the number of people who were affected and the period for which they were affected would be reduced, and money was put in to ensure that that was possible. If the hon. Gentleman looks at the new structure that is being put in place for pensions, he will see that women will actually be some of the greater beneficiaries of the new structure.

Chris White: I welcome the fact that the Prime Minister has raised awareness of the importance of child mental health this week, not least because 65% of young people requiring mental health support in south Warwickshire last year had to wait over 12 weeks before starting treatment. Will my right hon. Friend outline how the new proposals will improve our support network for such vulnerable young people?

Theresa May: My hon. Friend raises an important issue, which was of course alluded to earlier in this session of Prime Minister’s questions. We are investing more in mental health than ever before—we are spending a record £11.4 billion a year—and it was of course the Conservative-led Government that introduced parity of esteem between mental and physical health, but as I said earlier, there is more for us to do in ensuring that appropriate care is available for people. I cited an example earlier of where I saw excellent work being done to provide care and support for people in the community, which was relieving pressure on accident and emergency, but also ensuring that people were getting the best possible care for them, and that is obviously what we want to see.

John Woodcock: The strained accident and emergency provision in my constituency is under review, and the community further up the Cumbrian coast risks losing 24-hour access to accident and emergency and to consultant-led maternity from its local hospital. I understand that the Prime Minister will say that these decisions are to be made locally, but will she at least say that she can understand the anxiety of expectant mums who face a 40-mile journey on difficult roads, which are often blocked, if they have a difficult birth?

Theresa May: The problems that are facing the health service in Cumbria are widely recognised, and I do understand the concerns of local people about the services that will be available for them. We have put robust national support in place to address some of the long-standing challenges in Cumbria, and we are developing a lasting plan to deliver the high-quality, sustainable services that patients rightly expect.
The hon. Gentleman is right that these specific decisions are being taken locally, and no final decisions have been taken. I recognise the concern that he has raised previously, particularly about services at West Cumberland hospital. There will be considerable involvement in taking those decisions, but as I say, we do recognise the local concerns about some of the long-standing challenges for health service provision in Cumbria.

Dr Caroline Johnson: I know from my career in medicine that the men and women of our East Midlands ambulance service do a brave and sterling job for the people of Sleaford and  North Hykeham and others, saving people’s lives every day. East Midlands ambulance service responded to a total of 11,662 999 calls over the Christmas bank holiday weekend alone, 2,500 of which were in Lincolnshire. Will the Prime Minister join me in paying tribute to their dedication, particularly over the busy winter period, and tell the House what more the Government can do to support our ambulance services and improve response times in rural areas such as Sleaford and North Hykeham?

Theresa May: May I thank my hon. Friend for her question, and also for bringing her personal experience as a medical professional to this issue? I am very happy to join her in paying tribute to the men and women of the ambulance service for the dedication and commitment that they show. She asks what the Government have been doing. We recognise that ambulance services are very busy, which is why we see over 2,000 more paramedics now compared with 2010, and we are increasing paramedic training places by over 60% this year. Also, the Department of Health, NHS Employers and ambulance unions have agreed changes to the compensation for paramedics, potentially giving them a pay increase of up to £14,000 as they progress. We recognise the excellent work that they do.

Gavin Robinson: May I commend the Prime Minister for her considered statement last night and, indeed, for the words that she has given this afternoon? She knows our commitment to the institutions in Northern Ireland, but would she agree that nothing can be, or should be, gained from threatening the peace process, the progress that we have made or the institutions that we have fought so hard to sustain in Northern Ireland?

Theresa May: The progress that has been made in Northern Ireland has been hard won, and we must all recognise that we do not want to put that progress in jeopardy. That is why it is so important for the Government, and for all parties, to work as hard as we can to see a resolution to this issue, so that we can see a return to the power-sharing institutions and ensure that the hard-won progress can be continued.

Nicky Morgan: I warmly welcome what my right hon. Friend said about children’s mental health earlier this week, but may I draw her attention to another burning injustice? My constituent Paula Edwards has been battling cancer for four years. She is recovering from an operation and has taken 28 weeks off work. She is still employed and is on half pay, yet her working tax credits have been stopped, which means that she is worrying about how to make ends meet rather than focusing on her recovery. Will my right hon. Friend ask the Treasury to look at this, perhaps in the course of Budget preparations?

Theresa May: I thank my right hon. Friend for her comments about the mental health announcements that I have made. I am sorry to hear of the particular difficulties that her constituent is experiencing and the distress that they have caused her. Of course, working tax credits provide support for low-income families in work and are designed to incentivise people to increase their working hours. With the new universal credit system, we will obviously have a system of benefits with single, streamlined payments that encourages work, but I am sure the Financial Secretary to the Treasury would be happy to look at the individual case that my right hon. Friend has raised and the issue that she has set out.

GREEN INVESTMENT BANK

Caroline Lucas: (Urgent Question): To ask the Secretary of State for Business, Energy and Industrial Strategy if he will make a statement on the sale of the Green Investment Bank.

Nick Hurd: The Government set out their plans for the sale of the Green Investment Bank in the document “Green Investment Bank: Sale of Shares” laid before Parliament on 3 March 2016. The Government intend to move the GIB into the private sector, so that it can increase its access to private capital and increase its green impact free from the constraints of government ownership. Potential bidders are interested in the GIB precisely because of its green specialism. We are asking potential investors to confirm their commitment to GIB’s green values and investment principles, and how they propose to protect them, as part of their bids for the company. In addition, the Government have approved the creation of a special share, held by independent trustees, to protect GIB’s green purposes in future.
As I am sure the House will appreciate, the sale is commercially sensitive so I cannot comment on the identity of any bidders, or the discussions taking place between the Government and potential bidders. All parties have been required to sign confidentiality agreements that place strict restrictions on the disclosure of information. The restrictions apply to both bidders and the Government.

Caroline Lucas: I thank the Minister for his reply, but it gives very little reassurance, given that everybody knows who the preferred bidder is. The preferred bidder, Macquarie, has a very, very worrying and dubious track record. I am putting this question today with support from across the House.
This week, we heard that the Green Investment Bank stands on the brink not just of being flogged off but broken up, with its green purposes discarded. Founded in 2012, the GIB has been widely recognised as a true success story, kick-starting truly innovative low-carbon projects across the UK, yet the preferred bidder—Macquarie—not only has a dismal and terrible environmental record but an appalling track record of asset-stripping. So why have the Government given preferred bidder status to this company? What assessment have the Government made of Macquarie’s record, given that in 2005 the board of the London stock exchange deemed Macquarie unfit to conduct a takeover?
Furthermore, research this week uncovered changes to the GIB’s corporate structure. Between 22 November and 1 December, 10 new companies were incorporated and registered to the GIB’s London offices. The changes suggest that Macquarie is planning to fundamentally hollow out the GIB. Why have the 10 new companies been set up? Will the Minister confirm whether the changes made at the end of last year were made at the behest of Macquarie? Why are the Government setting up a structure to invite in a property asset stripper? If the GIB has been restructured in such a way as to  allow it to be stripped of its assets, how can the Government guarantee that the special share, supposedly introduced to protect the future of the GIB, will have the intended effect?
Is this not exactly the wrong time to be selling off the GIB, given that the Government have decided to embark on a new industrial strategy which must, to be in accord with our own climate change commitments, have low-carbon projects at its core? Finally, will the Minister admit that this selling off could lead to the bank being fatally undermined as an enduring institution? Will he stop the killing off of the Green Investment Bank? Will he halt the sale process with immediate effect?

Nick Hurd: As I think the hon. Lady knows, she has asked a stream of questions to which I cannot give direct answers. She will also know, being an experienced Member, that I cannot comment publicly on the identity of bidders or the process under way, for the reasons I elaborated at the start. She draws a lot of conclusions from media speculation, on which it would be irresponsible for me to comment, but I will try to give her some reassurance, flowing back to the objectives behind the sale that I set out in my answer. It is precisely because we want the GIB to be able to do more, unfettered by the constraints of the state, that we are seeking to put it into the private sector.
The objectives that we set out in the sale could not have been clearer and have been discussed in the House, and they include clear objectives around securing value for money for the taxpayer, which must be our primary responsibility. We want to ensure that the GIB can be reclassified to the private sector, but we have also been clear that we want to move it into the private sector to enable the business to grow and continue as an institution that supports investment in the green economy. We are selling it as a going concern, and potential investors would have to buy into the company’s green business plan and project pipeline. These are the criteria that we have set and against which we are evaluating the proposals before us.

Peter Aldous: The GIB is a tremendous Conservative success story. It was devised by the Conservatives pre-2010, probably by my hon. Friend the Minister, and was introduced by a Conservative-led Government, and it has been a great catalyst for investment in the green economy—I am thinking, in particular, of the Galloper wind farm off the East Anglian coast. There is a concern, however, if the press stories regarding asset stripping and job losses are to be believed, that it will not be able to perform that role in the future. In that light, will he consider a pause in the process so that we can ensure that the GIB continues to perform the great role it has played since 2012?

Nick Hurd: I agree with my hon. Friend’s opening comments about saluting what has been a great success story of the coalition—let us maintain the season of good will—but Conservative-led Government. It was the right thing to set up, it was we who did it and it has been a great success, having mobilised £8 billion of private capital into a critical area of infrastructure, according to the last figures. I can, however, assure him—he is far too experienced to be drawn or influenced too much by media speculation—that we are not being naive in this process. We have set clear criteria for the sale, we have run a genuinely competitive process and we are now evaluating the proposals before us, through the lens of the criteria we have set, which include value for money and reclassification. We are selling a going  concern, and what we want to hear about are forward plans for a dynamic, ongoing concern seeking to mobilise more private capital into the green economy. He knows as well as anyone in the House that we need to mobilise a lot of private sector capital to get the clean energy we need.

Clive Lewis: I hope the Minister would agree that the GIB is a great British success story—he has already said as much—but let us put the record straight: it is also a Labour success story, having first appeared in our 2010 manifesto, and I am glad that the coalition Government took it up. If it is a success story, however, why are they selling it off? Is it simply a case of “public good, private bad”? That is what we think on the Opposition Benches, but Conservatives think it is “private good, public bad”. I am telling the House, quite simply, that from the assessment of Macquarie and what we have seen of it, we see that it has a history of asset stripping, so how exactly will the Minister protect this valuable public institution from having its assets sold off? That is a very fair question.
We know that the Government had planned to hold a share in the bank, which would have helped to maintain its green purposes, but new evidence has shown that Macquarie has already set up new companies that will control the GIB’s major assets. Will the Minister elaborate on the purpose of those companies and what oversight the Government will have of them once the sale goes through? The Prime Minister told us that the industrial strategy would be at the heart of her Government, yet the Government are now selling off an institution that has succeeded, from scratch and against the odds, in attracting capital for our green infrastructure on commercial lines. The Minister has already been outmanoeuvred by Macquarie bank and, frankly, we do not have much confidence that it will not happen again. Will the Government agree to stop the sale of the Green Investment Bank today until such time as its green purpose and core assets can be genuinely protected? If the Minister will not, does he accept that the GIB’s fate rests on his shoulders?

Nick Hurd: I will pass over the bizarre claim that the GIB is a Labour success story by virtue of its simply being mentioned in a 2010 manifesto, with nothing done for 13 years in government prior to that. This meant that in 2010, we started with far too low levels of clean energy in this country—a situation transformed by the coalition Government. Again, I caution Members against making assumptions on the basis of speculation in the media, and I am not going to comment on that or identify any bidders.
The hon. Gentleman reflects the different view across the House about the benefits and values of the private sector. He should be aware, holding the position that he does, that we need to mobilise a huge amount of private capital. It is private capital, not public capital, that is going to make the difference when it comes to the big shift in infrastructure. What he misses is the critical role that the state has played in setting up the GIB to correct a market failure. The fact that we have run a competitive process and that private sector bidders have come up and said, “We want to buy this as a going concern because of its green specialism”, indicates that the market failure has, to a large extent, been corrected.  The fact that this institution has mobilised billions of pounds of private capital into this critically important area of infrastructure is a success story. Our whole instinct now is that because we want it to do more, it will do more and be an even more successful institution in the private sector as a going concern.

Rebecca Pow: The Government have always been clear that the GIB was designed with a view to a possible transfer to the private sector, so will the Minister assure the House that the purpose of the GIB is, and will remain, green investment? I know that the Minister is dedicated to environmental issues, so will he also assure us that we will stick to our laudable manifesto pledge of leaving the environment in a better situation than we found it?

Nick Hurd: I thank my hon. Friend for her positive observation, and pay tribute to her record and her absolute integrity and authenticity on protection of the environment and climate change which are well respected across the House. I can give her this assurance. We have put before Parliament the whole procedure for protecting the green purpose of the GIB through the special share arrangements. It will be held by an independent company and it will have the power to approve or reject any proposed changes to the GIB’s green purposes. This is going to be set in company law. The five trustees were announced on 31 October 2016, selected through a genuinely independent process. If my hon. Friend looks at the names, she will see that they are independent and extremely credible. That is the mechanism that we have set out. I return to the point about the objectives of the sale. We want this to go into the private sector, so that it can do more of what it is doing—unfettered by the inevitable restrictions that the state has to put on it at this stage.

Callum McCaig: I thank you for granting this urgent question, Mr Speaker, and I thank the hon. Member for Brighton, Pavilion (Caroline Lucas) for putting it. We support it wholeheartedly. The Minister has repeatedly said that he wants to see more money raised through this, but it will not happen if the assets are stripped from the company and taken abroad. Also, this is happening at precisely the worst possible time. There are reports that we will see a 90% fall in renewables investment. That must be addressed, and the GIB should be the vehicle for doing that.
What assurances can the Minister provide that capital from existing assets will be reinvested in green projects in the UK? How will the golden share work when it comes to subsidiaries and, in particular, to having a say over asset sales? What reassurances can he give us that the headquarters in Edinburgh will continue? How will the Government ensure that the shortfall in investment in renewables will be met? Finally, in the light of the forthcoming industrial strategy and emissions reduction plan, will the Minister pause this sale, so that Parliament can properly look at these and see what role the GIB can play in that process?

Nick Hurd: The hon. Gentleman quite rightly talks about the need for investment in renewables, but it would be nice if he could give more recognition of the extraordinary progress this country has made in respect of the profound transition to clean energy and the fact  that we have generated more electricity from renewable energy than from coal this year, which is a pivotal moment in our history. Investment continues to flow, and the GIB has played and I am sure will continue to play a very important role as a catalyst for all that.
I understand that the hon. Gentleman seeks reassurances and share his sentiments, but this is part of our process of evaluating the proposals before us against the criteria transparently set out and agreed through the House. It is through that lens that we now evaluate the proposals, which obviously includes attitudes to the workforce and sensitivities around jobs in Scotland. This is all part of the criteria and is, as I say, the lens through which we look at the proposals. Beyond that, I cannot say much because of confidentiality, and I hope the hon. Gentleman will respect that.

Huw Merriman: For the Opposition business spokesman to make the sweeping generalisation that “private is bad” is, I find, an appalling indictment, which provides evidence of why millions of private sector workers cannot rely on the Opposition. When the Minister looks at the golden share, will he consider whether some guarantees could be provided for future investment and in relation to the existing portfolio, perhaps for the first couple of years during the transfer to any bidder?

Nick Hurd: I thank my hon. Friend for that constructive observation. He is quite right in his first point—“public good, private bad” could not have been clearer from the Opposition Front Bench. That will have been noted in the business community and across the country, reinforcing the question mark that the country’s business community has about the Labour party’s attitudes towards it.
On the green share and the maintenance of assets, I have set out the mechanisms; I think they are robust, and Parliament agreed that they were. As for so-called asset stripping and the freedom to sell assets, let us not get ourselves into a position in which we view holding assets for ever as a good in itself. I do not think we would want that for the GIB under its current structure. The management of the organisation has to be free to manage a portfolio. As a Government, we have to be practical about the limitations we would place on a private sector bid. I come back to the point that we have been very clear about the criteria we are setting for this sale, and we are looking at proposals by taking a holistic view of those criteria, which include the need for reassurance about the forward plans for the organisation and the level of ambition for mobilising private sector capital into this critical area of clean infrastructure.

Ed Miliband: In the interests of consensus, we can agree that there was cross-party support for the Green Investment Bank right from the get-go. I would say to the Minister that there is also cross-party concern about this sale—and I could mention Lord Barker, who was a Minister in the last Parliament, Vince Cable and of course people on the Labour side. Is not the key question for the Minister and the Secretary of State this one? They promised a new approach to industrial strategy with a new Department, by contrast with their predecessors who did not even  use the phrase “industrial strategy”. The question to the Minister is: what has changed since they took over? If there is a moment to prove commitment to the new industrial strategy, it is this one in respect of their plans for the GIB.

Nick Hurd: The right hon. Gentleman may be right about the cross-party agreement on the need for a GIB; the difference is that we did it, and he did not. His party had plenty of opportunity to do it. He talks about the need for a continued commitment to investment in renewables, and I think we have shown that. In fact, one of the most decisive steps this Department has taken in the short time we have been in power is the announcement of the new contract for difference auctions, which will be the next stage of support for the more mature renewable tech choice. There is no issue about this Government’s commitment to the low-carbon economy and the green infrastructure that needs to underpin it. The Secretary of State could not have been clearer about that. Where I think there is a divergence of view is that the Labour party seems to think that state ownership is a good in itself, whereas in this situation we feel we have moved on from that. When it comes to this very important organisation that has done a great job, we want to liberate it so that it can do more in future. It is partly through that lens that we are looking at the proposals before us.

Oliver Letwin: Does my hon. Friend agree that the test—the proof of the pudding—lies not in how many existing assets of a given kind are owned, but in whether there will be a greater or smaller amount of investment in renewable and other green energy projects in the future? Does he agree that this privatisation will prove to have been a success if the level of investment in new projects increases as a result of it?

Nick Hurd: I am delighted to respond to that question from my right hon. Friend, who was, in many respects, the guardian angel of the coalition Government, and who was intricately involved in the deliberations that led to the establishment of the Green Investment Bank. He is absolutely right, and he has made a fundamental point. We should not necessarily judge the bank on the basis of what it is at the moment; this is about what it can become, about levels of future investment, and about commitment to the green purpose of the organisation. I do not think that the Government could have been clearer about the priority that we attach to those considerations. This is about the future.

Iain Wright: May I give the Minister another opportunity to answer the question that I asked him in the Select Committee yesterday? How can he reconcile insisting on preserving the green purposes of the bank and preventing asset-stripping from a new buyer with satisfying the classifications of the Office for National Statistics in respect of public sector control and balance-sheet requirements post disposal?

Nick Hurd: I have great respect for the Chairman of the Business, Energy and Industrial Strategy Committee, and we had a useful exchange about this issue yesterday, but he is again making assumptions about asset-stripping. He is aware of the structure that we have established,  having doubtless been involved in the parliamentary debate about it. There is a great deal of concern on both sides of the House about protecting the integrity of the green purpose of the GIB, which is why we have gone through the process—which I think is robust—of setting up what is effectively a green share, along with the mechanism for its governance. That system was, I think, agreed to by Parliament, and was introduced formally with the protection of corporate law.
I return, however, to the human motive of those who want to buy this organisation, which is to enable it to grow and do more. It is the authenticity, sincerity and integrity of those proposals that we are now evaluating.

Kevin Foster: I am sure the Minister shares my slight amusement at the Opposition’s argument that you can believe everything you read in the press about the Green Investment Bank, given that they spent all yesterday afternoon arguing that you cannot believe everything you read in the press. Does he agree that the Green Investment Bank was set up to deal with a market failure, that the fact that private investors are now keen to come in demonstrates the purpose it has served, and, in particular, that without the restrictions imposed by EU state aid it can deliver more investment, not less?

Nick Hurd: My hon. Friend has made—much more eloquently than I have so far succeeded in doing—exactly the fundamental point that we are trying to convey. The test of an organisation that was set up to correct a market failure is whether that failure has indeed been corrected. We believe that it has, and our view is supported by the large amounts of private sector investment that are flowing into green infrastructure in the United Kingdom and around the world. What we must do now is ensure that the GIB is free and unfettered by the state so that it can do more.

Mary Creagh: The Environmental Audit Committee’s report on the sale of the bank stated that Ministers had rushed to privatise it without consultation or proper consideration of the alternatives, and that either it should continue to exist as a low-carbon investor or its sale should not proceed. Taxpayers do not want a repeat of the Royal Mail debacle, when a public asset was sold off at £1.4 billion below its true value, and they do not want this landmark British institution to be sold off to an asset-stripper.
Is it not extraordinary that the bank’s assets were restructured in November? Can the Minister tell us whether that was done at the request of the UK Shareholder Executive in order to facilitate its sale to the preferred bidder?

Nick Hurd: I do not believe that that was the case at all, although I understand the points that the hon. Lady has made. Like any other Government, we have a responsibility to deliver value for money to taxpayers, and we are very conscious of the need for this deal, if it materialises, to present itself well to the public whom we serve and represent. That is why, as one would expect, value for money is at the top of our list of criteria. We are embarking on a very good process, and we are setting ourselves very high standards for the presentation of the deal.

Kevin Brennan: I remind the Minister that during the passage of the Bill that became the Enterprise Act 2016, the Government rejected a Labour amendment that would have guaranteed the green purpose of the bank. Will he give an assurance today? After privatisation, will the bank be free to invest in fracking projects?

Nick Hurd: Let me respond to the hon. Gentleman’s substantive point about the protection of the green purpose. If he doubts the integrity of the mechanism that we have established, that is fine, but I think Parliament has recognised that it is a robust mechanism, whereby the green purpose is set in the articles of association and any change must to be given effect by an affirmative resolution of the trustees. It is worth our noting the integrity of those people: James Curran MBE, Trevor Hutchings, Tushita Ranchan, Lord (Robin) Teverson—a very public sceptic of this process—and Peter Young. That is a very good group of people, selected by a rigorously independent process to safeguard the integrity of the green purpose, which is a priority for the Government.

Luciana Berger: We were told that we were to have the greenest Government ever, but the failed green deal collapsed, investment in renewable sources has been slashed, and we have slipped in the world rankings for investment in the low-carbon economy. If the Minister is not persuaded by the moral and environmental reasons why supporting the green economy is vital, will he consider, as a matter of urgency, the financial and economic reasons why it is crucial for us to invest in it, and will he then reverse his decision on the Green Investment Bank?

Nick Hurd: The hon. Lady is flogging rather an old horse, and, if I may say so, that is completely misplaced. Significant investment is being made in clean energy in this country and around the world. Indeed, with the Hinkley deal the Government made one of the biggest commitments in the world to low-carbon energy. There is no question about our commitment to the transition to a low-carbon economy and a clean energy structure, and we are well along the track. I would add that we inherited an arrangement whereby we were operating on far too low a base in terms of renewable energy. It was a coalition Government led by Conservatives who changed that.

Alex Salmond: The Minister refused to name the bidders for the Green Investment Bank, but went on to tell us that private companies were saying that they wanted to buy the bank because of its success. Will the Minister tell us which private companies were saying that, or did he make up the quotation?

Nick Hurd: The right hon. Gentleman is extremely experienced, and I am not sure what part of a confidentiality agreement he does not understand. As I have said, the Government’s criteria could not be clearer: we are selling a going concern, and we are not interested in proposals that do not respect that.

Dennis Skinner: When are the Government going to learn the lessons of the past when it comes to selling off public assets? I was here when Mrs Thatcher decided to sell off not only electricity but  gas, and then, finally, water. She said we were going to be a British share-owning democracy: that was the phrase. If we look at the list now, we find that some of those companies are owned in Germany and some are owned in France—and Macquarie, in Australia, bought the Birmingham toll road in a flash under a Tory Government.
Today we are being given another lecture on how the Minister will preserve the identity of the Green Investment Bank. History tells us that that is not possible. The bank will go to those who are bidding for it, and they will not be just in Britain. We are in the process of leaving the EU, and the chances are that somebody in the EU will be buying up British assets—although maybe not this one. Why don’t you learn the lessons?

Nick Hurd: Of course, one of the lessons of privatisation can be seen in the record levels of investment that have flowed into those organisations since they were privatised. I respect the hon. Gentleman’s experience, and I respect his sincerity and integrity, but I think he is totally wrong. All I will say is that I have a strong instinct that he would like British Telecom still to be a public company. I will leave it at that.

Kerry McCarthy: The Minister is being very dismissive about speculation in the press. However, in the Financial Times the former Business Secretary Vince Cable has expressed concern about asset-stripping, which he thinks was Macquarie’s objective, and Ed Davey, the former Energy and Climate Change Secretary, has said he considers it unlikely that the golden share would give Ministers enough clout to influence the bank’s investment strategy. Does the Minister not think that those two people—who, after all, were very much involved in the setting up of the bank—should be taken seriously, and that we should act on their concerns?

Nick Hurd: Let me assure the hon. Lady that I take seriously all the concerns expressed by politicians past and present. It is important that through this urgent question the concerns that people have go from this House to potential bidders. I absolutely respect that and the individuals she mentions, but she says I am dismissing media speculation. I am not; I am just not commenting on it, because Ministers should not.

Mark Williams: I thank the hon. Member for Bristol East (Kerry McCarthy) for reminding the House of the involvement of Liberal Democrats in initiating the Green Investment Bank. Can the Minister address the point raised by Sir Vince Cable in a letter to the Secretary of State that he remains unconvinced that the golden share will prevent the asset-stripping of the company and therefore the original intentions of the green bank at its inception will be under threat?

Nick Hurd: There was a whole set of arrangements under which the special share solution was reached. It was debated through Parliament and settled through that process. My personal view is that it is a robust mechanism in itself given its legal underpinning and the integrity and independence of the people selected to be  the trustees and guardians of the process. I also come back to the fundamental point about the motivation of people who might want to buy this organisation, and the lens, criteria and disciplines we will have in evaluating their proposals and deciding whether or not to go ahead.

Ian Murray: I, along with many colleagues, fought for the headquarters of the GIB to come to Edinburgh, where it now has more than 50 staff. Can the Minister tell us how many of those  50 staff will remain in Edinburgh after privatisation?
Many people have mentioned Vince Cable, but the legacy of Vince Cable as Business Secretary is the botched privatisation of Royal Mail, and that is why people have concerns about the GIB. The reason why we have concerns about the sale of assets is that by its nature the GIB invests in projects that the market will not touch, and therefore when those projects come on-stream they are much more profitable than normal projects, and if a preferred bidder then sells them off, they will sell them at great profit at the taxpayer’s expense.

Nick Hurd: I recognise the importance of the GIB to Edinburgh and have agreed to meet with the Members of Parliament for that area to discuss this process. It was entirely the right decision to locate part of the organisation there, and jobs are a part of what we want to hear from bidders; we want to hear about commitment to staff and the ongoing organisation.
As the hon. Gentleman has mentioned staff, let me place on record—I hope this is shared by Members across the House—the Government’s admiration and respect for the senior management team and all staff at the GIB, led by Lord Smith and Shaun Kingsbury, not just for what they have achieved in a relatively short period, but for the professionalism with which they have conducted themselves during this process.

Hywel Williams: The GIB has made substantial investments in Wales, most recently at Parc Adfer on Deeside in partnership with five local authorities. That model works pretty well. What guarantees can the Minister give that the new owners will continue to invest in that sort of way, and invest in the regions and nations of the UK rather than abroad, or possibly even in the golden south-east?

Nick Hurd: I return again to the main point about the questions we ask of bidders and the criteria we set. We want to achieve value for money; we are selling an ongoing concern, and we are determined to protect the integrity of the green purpose of the organisation, so we want to hear plans for the mobilisation of future investment and future capital. If models are working, I am sure that any bidders that are professional organisations that view the GIB as a business will have regard to them. That is what we want to hear from bidders, and we are at the point in the process where we are evaluating that. I am afraid I cannot say a great deal more beyond that.

Jenny Chapman: For the sake of transparency, can the Minister tell the House whether the GIB will be able to invest in fracking in the future?

Nick Hurd: The GIB will be required under this process to continue to respect the green purpose of the organisation, as set out in the articles of the association. The degree to which investment proposals fit those criteria is a judgment to be made by management and the trustees that we have set up to be independent guardians of this process.

Mark Durkan: When Vince Cable was legislating for the GIB, we got assurances that it would operate throughout the UK and support projects in Northern Ireland, and, importantly, would not be precluded from supporting cross-border projects. In fairness, one of its first investments was in Northern Ireland, and indeed in my constituency. However, many of us are concerned that the quality of its investments, reach and support will be lost in this sell-off; the Minister talks about integrity but that is not something people associate readily with the preferred bidder.

Nick Hurd: I am not going to comment on either the identity, character or values of any bidder at this stage, but I join the hon. Gentleman in recognising the good work done and the approach taken by the GIB in making sure its investments are spread across the country. I come back to the point that the motivation for our wanting the GIB to be in the private sector is to enable the business to grow and continue as an institution supporting investment in the UK green economy—the reference to the UK there is important.

Julie Elliott: I have been listening to the Minister rewrite the history of this Government’s appalling record in this area since 2010, but the GIB is the one success story, and it did have cross-party support. It does a magnificent job in supporting risky businesses that the rest of the market will not invest in. Without breaking any confidentialities around the ongoing negotiations, what guarantees can he give to this House that such risky investments will continue and that green investment will be in as good a state as now, or even better, in five years?

Nick Hurd: I am forced to repeat myself again. We have set up, in a process agreed through Parliament, a mechanism for protecting the integrity of the green purpose of the organisation. Beyond that, because we are serious about selling the bank as a going concern and want to see positive proposals for growth and future investment, we are evaluating proposals from bidders against that lens. We are, and will continue to be, influenced in that process by the attitudes of the senior management team and what they feel about the proposals.

George Kerevan: Last year, Macquarie—to cite a company at random—made its largest ever profit, and it did so, as the markets will tell the Minister, by selling off Moto, Britain’s largest motorway service company, taking the cash out of the company and giving it to shareholders. Will the Minister tell us what in the current safeguards will prevent the future buyer, whoever they may be, from doing what Macquarie has always done: selling assets, taking the money out of the company, and using it to pay its shareholders?

Nick Hurd: Again, I must repeat myself. The hon. Gentleman has chosen a company at random, but I am not going to talk about any companies. What I have  tried to labour is the seriousness of purpose behind this process and the safeguards we have set up, which are protected in law and also by the criteria we have set in evaluating any bids. An important part of that is the forward intention and the intention to mobilise private capital in future.

Diana R. Johnson: Given Brexit and the uncertainty around it, is it not risky to sell the GIB at this time? How does the Minister envisage Government ensuring that money will be available for the new innovative technologies that will be very important for areas such as mine in Hull and the Humber?

Nick Hurd: With respect to the hon. Lady, I am not entirely sure why Brexit is relevant to this process or to the decisions underpinning it. I agree 110% with her fundamental point about the need to invest in energy innovation, which is why our Department has a £500 million spending review portfolio dedicated to energy innovation that sits in a wider system of budgetary support for energy efficiency. The point she makes is entirely the right one: if we are to achieve what we want to achieve in decarbonisation and the transition to abundant sources of affordable low-carbon energy, we have to continue to innovate. The Government have a role in that, which is why budgetary support is available for it.

Joanna Cherry: The Green Investment Bank employs 55 people at its head office in my constituency. When it was set up in 2012, the then Business Secretary, Vince Cable, said:
“Edinburgh has a lot going for it, both in terms of it asset management and finance sectors…also its proximity to green energy activity”.
He also said that choosing Edinburgh supported what he described as the “wider narrative” of binding Scotland into the UK in the run-up to the independence referendum. Will the Minister meet me to discuss how such promises can now be delivered to those 55 employees who work in the head office in my constituency?

Nick Hurd: I extend to the hon. and learned Lady the same offer that I made to a colleague earlier. Of course I will meet any colleagues whose constituencies may be affected by this process.

Catherine West: My question relates to the bidding process. What is the Minister’s view of the Macquarie bank, the potential bidder also known as the “cuff-linked buccaneers”? What is his opinion of the bank’s recent activity as the owner of Thames Water when it shipped off hundreds of millions in dividend payments to investors, paid minimal taxes and made disappointing investment in the network?

Nick Hurd: The hon. Lady has made her point, and she will know what point I am going to make. I cannot possibly comment on the identity of any bidder at this stage.

Sammy Wilson: Does the Minister agree that, if green investments are as profitable, sound and attractive as their supporters have claimed in the House today, there should be no concern about the  introduction of private finance for such projects? Indeed, given the pressure on the public purse at the moment, is he not surprised that the House is not welcoming another source of funding for these activities?

Nick Hurd: The hon. Gentleman makes an important point about the increased attractiveness of investment in renewable energy and low-carbon infrastructure. Governments in the UK and around the world have helped to facilitate that investment over the years and have seen dramatic falls in the cost of those technologies and the cost of the capital attached to them, making them a more investable proposition. This helps to reinforce our argument that this is the right time to liberate the GIB from state control to enable it to play a bigger part in the market.

Margaret Greenwood: The Aldersgate Group has highlighted the fact that the strength of the Green Investment Bank is that it has supported innovative projects throughout the UK that help us not only to tackle climate change but to drive down costs in the NHS and local government through energy efficiency. Will the Government heed the warning of the former Conservative Energy Minister, Lord Barker, that the bank is heading for break-up? Will they halt the sale to ensure that the bank remains a single public institution that is one step ahead of the market in the green projects that it backs?

Nick Hurd: Lord Barker is a good friend of mine for whom I have great respect. I would like to reassure him and, I hope, the House that the Government are not being naive. We are very clear about the criteria we have set, and we are in the process of a robust and rigorous evaluation of the proposals against those criteria.

Matthew Pennycook: The Minister has been very clear that the creation of a special share in the governance arrangements will protect the integrity of the bank’s green purpose and future investments, but may I press him for a little more detail on precisely how that special share would prevent successful bidders—Macquarie or others—from offloading current projects?

Nick Hurd: I want to make two points on that. First, the special share is being set up to protect the integrity of the green purpose, which is set out in the articles of association. It is there for all to read. Any proposed changes would need to be approved by the trustees, who have been selected independently. That is the mechanism involved. Secondly, I made the point earlier that I do not think it is sensible for investment institutions to hold on to assets for ever. Part of their role is to manage  a portfolio, and if they get attractive offers to divest assets we expect them to look at those offers seriously. We are interested in the plans for future investment, and in what this organisation could become under private ownership. That is what we are evaluating.

Hannah Bardell: The Minister was right to say that there was cross-party support for the Green Investment Bank. There was, however, no such cross-party support—or support in Scotland—for the removal of support for carbon capture and wind energy. The fact that his party’s policies have been so disastrous in Scotland might explain why it does not do so well with the electorate there. Will he absolutely commit to all the projects that the Green Investment Bank has invested in—totalling hundreds of millions of pounds in Scotland—and assure us that, regardless of who the buyer is, they will continue?

Nick Hurd: I dispute the hon. Lady’s analysis. This country has made enormous progress in the shift to clean energy, and Scotland has been a big part of that. I point her to the recent commitment to the next round of contract for difference auctions, and to the fact that last year I think we generated 25% of our energy from renewable sources. If she looks at the starting point of 2010, I think her argument falls away. On her point about continued investment in Scotland, I repeat what I have already said to colleagues.

Margaret Ritchie: When taken alongside the cuts to renewable energy and the abolition of the Department of Energy and Climate Change last year, does not the sell-off of the Green Investment Bank show that the Government are no longer committed to being a world leader on climate change and sustainability?

Nick Hurd: No. I am afraid that that is total nonsense. If the hon. Lady wants proof points on that, I can tell her that one of the first actions of this Department, within days of the new Government being formed, was to put into law the fifth carbon budget. I am sure that she knows the detail of that, so she will know how ambitious it is. That was not the action of a Government who are shirking their responsibilities in relation to Britain’s role in mitigating climate change.

Alan Brown: Is the Minister seeking assurances that 100% of the return on any sales of existing assets will be reinvested in green energy in the UK?

Nick Hurd: I think I have laboured to exhaustion the point that one of our priorities is to protect the integrity of the green purpose of the organisation. What we want to hear from bidders is their plan for future investment.

Point of Order

Tom Brake: On a point of order, Mr Speaker. The Attorney General is making a speech today—indeed, he might already have made it—that will apparently pave the way for more military drone strikes against jihadis. This looks like, smells like and walks like a policy announcement. You, Mr Speaker, will be aware of the concerns that have been expressed in the House about the use of drones, about the lack of parliamentary scrutiny of their use and terms of engagement, and about the risk—acknowledged by the Attorney General—of civilian casualties associated with their deployment. Given the controversial nature of drones, do you agree that any step change in their use—in other words, a policy shift—should be raised and debated in this House, not trailed in a speech?

John Bercow: I am grateful to the right hon. Gentleman for his courtesy in giving me notice of his intention to raise this point of order. I certainly share his view that significant policy announcements by the Government should first be made in this House rather than outside it. I am not familiar with the contents of the Attorney General’s speech today, and I am not in a position to pronounce on whether it amounts to such an announcement of policy change. That said, the right hon. Gentleman has made his concern clear, and it will no doubt have been heard by those on the Treasury Bench. He can be sure that it will be conveyed to the relevant Ministers. The fairest thing I can say is: let us await events. I might add that as the right hon. Gentleman is a former Deputy Leader of the House, he will be well aware of—and personally closely familiar with—the instruments available for Back-Bench scrutiny of the Executive in this place.

GUARDIANSHIP (MISSING PERSONS)

Motion for leave to bring in a Bill (Standing Order No. 23)

Kevin Hollinrake: I beg to move,
That leave be given to bring in a bill to make provision about the property and affairs of missing persons; and for connected purposes.
Sooner or later, all parents come to a certain realisation: our children are gradually slipping away from us—first crawling, then toddling, then running. The gentle, guiding hand is no longer needed as, with great delight, they discover the trick of balancing on two wheels and there they go pedalling off down the lane. There is that first day at school and then, a few years later, their hand starts to slip from yours when they get anywhere near the school gates. The teenage bedroom years are spent in self-imposed solitary confinement. Then comes the day when they cram all their stuff into the boot of the car and are off to university or the first job or to move into their first home.
All are bittersweet moments for most parents, because most of us know that they will return. That is not so for Mr and Mrs Lawrence, parents of Claudia, a missing person since 18 March 2009—nearly eight years ago. We can never imagine the rising panic of those first minutes, hours and days when they realised something was wrong. Increasingly frantic calls and prayers go unanswered. Voicemails are never retrieved. Days turn into weeks, weeks into months, and months into years. Claudia’s fate is still unknown and still the subject of a police investigation. Many false hopes have been raised over the years. A lead? A prosecution? Nothing. Hopes raised; hopes dashed.
When a person disappears with no explanation, all the unanswered questions and difficult emotions leave their friends and family an unbelievable amount to cope with. Such desperate situations are worsened by the need to pick up the pieces of their lives, such as paying the mortgage, the rent, the car loan, or insurance. Data protection and financial services contract law currently prevent even the closest relative from dealing with their finances. Mr Lawrence told me:
“Banks, insurance companies, mortgage lenders, all say, ‘We can’t accept your instructions, as you’re not our customer’.”
He went on to say:
“You’re at your lowest ebb and you have to fight all these problems... it’s terribly distressing.”
I believe that the vast majority of Members join this House because they want a better world for all our children, but there are some problems that we will never be able to solve. The flaws of mankind will always exist. Our police forces cannot prevent and solve all crimes, but we can help by easing the burden in a small but important way.
Under current English and Welsh law, when a person disappears their property is effectively left ownerless. No one has the legal authority to protect it on their behalf. That can lead to assets depreciating and property falling into disrepair and leaves those left behind without access to the resources that the missing person would have provided. The creation of a new status of guardian  of the property and affairs of a missing person will fill that void and provide a sensible and helpful solution to the practical and financial difficulties faced by families and others following a disappearance.
The core of the proposal is that the court will have power to appoint a guardian on the application of a person with sufficient interest in the property and affairs of someone who is missing. The Bill provides that the person will generally have to have been missing for at least 90 days and that the guardian will take control of the property and financial affairs of the missing person and will have authority to act on behalf of the missing person. The guardian will be able to use the property of the missing person to help those left behind, will be accountable for his or her actions and will be supervised by the Office of the Public Guardian. The terms of the appointment will be for a period of up to four years but will be renewable by application to the court. The small fee involved will be payable by the missing person’s estate, so there will be little or no cost to the taxpayer. Crucially, the guardian will be required to act in the best interests of the missing person.
The proposals draw on the precedents of systems used in other countries, particularly certain states in Australia, and for deputies appointed under the Mental Capacity Act 2005. Many of us have benefited from similar powers in other difficult circumstances, such as when someone passes away or when someone close to us is no longer able to manage their own affairs due  to dementia or other mental capacity issues. Quite simply, this Bill fills a gap in the law that few people know exists.
There are some 4,000 missing people occurrences every year, and I thank everyone connected to Missing People, a support and campaign organisation, many of   whom are involved because they have lost a loved one. I offer particular thanks to Mr and Mrs Lawrence, who have a deep connection with my constituency and have championed the cause of guardianship even though it can no longer help their situation. I am also grateful to Members from across the House and from the other place who have pledged their support for this motion, particularly my hon. Friends the Members for York Outer (Julian Sturdy) and for Selby and Ainsty (Nigel Adams) and the hon. Member for York Central (Rachael Maskell), who have done so much work on this topic already.
Missing People has many tragic stories of loved ones lost and those left behind having their hearts broken: husbands, wives, fathers, mothers, brothers, sisters, and children. This is possibly one of those all too rare occasions when Members can make a huge difference simply by supporting this straightforward Bill.
I am grateful to the Justice Committee, for the work of the all-party parliamentary group on runaway and missing children and adults, and, crucially, to Ministers, who have pledged their full support for the Bill. All I respectfully ask for is the support of all hon. Members to guarantee the Bill’s passage through the House and into legislation.
Question put and agreed to.
Ordered,
That Kevin Hollinrake, Ann Coffey, Julian Sturdy, Christian Matheson, Sir David Amess, Christina Rees, Nigel Adams, David Warburton, Liz Saville Roberts, Rebecca Pow, Amanda Solloway and Dr Philippa Whitford present the Bill.
Kevin Hollinrake accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 3 February, and to be printed (Bill 120).

OPPOSITION DAY - [17TH ALLOTTED DAY]OPPOSITION DAY

NHS AND SOCIAL CARE FUNDING

Natascha Engel: I advise the House that Mr Speaker has selected amendment (a) in the name of the Prime Minister.

Jon Ashworth: I beg to move,
That this House supports NHS England’s four-hour standard, which sets out that a minimum of 95 per cent of all patients to A&E will be treated within four hours; notes the widespread public and medical professional support for this standard; further notes that £4.6 billion has been cut from the social care budget since 2010 and that NHS funding will fall per head of population in 2018-19 and 2019-20; and calls on the Government to bring forward extra funding now for social care to help hospitals cope this winter, and to pledge a new improved funding settlement for the NHS and social care in the March 2017 Budget.
I begin by paying tribute to the staff working in the NHS. To nurses, midwives, GPs, consultants, junior doctors, paramedics—all staff—we say thank you for your hard work, goodwill, commitment and dedication though this winter crisis. I had the pleasure of meeting some of those hard-working staff with my hon. Friend the Member for Tooting (Dr Allin-Khan) at St George’s hospital on Monday, and they told me of the pressures they face. Last night, I convened a summit of representatives of various royal colleges and trade unions working in the health service to meet staff and hear directly from the frontline of the pressures we now see in hospitals every day. Many royal colleges have spoken out today, warning of underfunding and understaffing. Over the past few days, I have received messages from doctors and clinicians from across the country who tell of the immense pressure, strain and, yes, crisis that we face this winter.
Let me share with the House some of the stories that I have been told, and I deliberately exclude the names of hospitals and trusts so as not to cause undue stress and alarm. This is a flavour of what I have heard. One doctor told me:
“There was a point when A&E was completely full and we had no space for a major trauma call that was coming in. The trauma case was going to have to be put into a corridor because the resuscitation area was full.”
Another story:
“In my A&E ‘Corridor Care’ isn’t unusual, it’s now the norm. Patient buzzers have actually been installed on the walls in said corridor.”
How about this:
“We’re…trying our best to keep patients safe but there aren’t enough of us and we’re on our knees. Doctor and nurses in tears”?
Another story:
“Over the weekend my bosses repeatedly asked for ambulances to be diverted away from our hospital because we had no beds, but we had multiple requests denied.”
Finally, another one:
“The A&E is perpetually rammed with the corridor full of ambulance trolleys and paramedics.”
I have many more examples, but I am sure the House understands the broader point that I am trying to make.

Angela Eagle: There is unprecedented pressure in Wirral, too. As recently as last week A&E attendances and GP referrals were massively up. Unprecedentedly, 84 additional beds are being laid on, and they are now full. Last week, all elective in-patient appointments were cancelled and ambulance turnarounds reached up to five hours. At Prime Minister’s questions, the Prime Minister did not seem to think that there is a crisis in the NHS. If this is not a crisis, can my hon. Friend tell us what is?

Jon Ashworth: My hon. Friend makes her point eloquently and represents her constituents powerfully, as she always does in this place. I hope the Secretary of State will respond to some of those points.

Rob Flello: The Royal Stoke in my city is under intense pressure. No doubt we will hear shortly from the Secretary of State that that is winter pressure. Winter has not really started. We have not really had a winter, yet we have been under this pressure not for a few weeks but for months. The whole NHS system is broken. That is the problem that we really face.

Jon Ashworth: My hon. Friend makes an eloquent point about the particular situation that has been facing Stoke for some time, of which many of us are aware. I hope the Secretary of State will touch on the situation in Stoke, because sadly it is one that we have had to raise previously.

Several hon. Members: rose—

Jon Ashworth: If I may, I will make a little progress. I promise to try to give way to as many hon. Members as possible.
I assure the Secretary of State that I will pass on the names of the trusts and hospitals that I highlighted, so perhaps he can look into them. Let us be absolutely clear that these desperate stories are not the words of politicians trying to score political points but are the honest, heartfelt, considered testimonies of doctors and clinicians on the frontline in our hospitals. They simply want to do the very best for their patients. Indeed, many clinicians want to speak out but feel that they cannot, which is why the remarks were made anonymously.
According to reports on the BBC’s “You and Yours”, the Prime Minister has sent instructions to hospital trust chief executives telling them not to speak out. I would be grateful if the Secretary of State could verify those reports.

Maria Caulfield: I worked in the NHS over the Christmas period. Although it has been a very tough winter so far, this is nothing new. I have worked in the NHS for more than 20 years, and under previous Governments we had ambulances queuing around the block to get into A&E. Major incidents were declared in A&Es because they were too full. Will the hon. Gentleman accept that this is not a new problem?

Jon Ashworth: I entirely respect the hon. Lady’s work as a nurse before she came into this place—[Hon. Members: “She still is.”] I beg her pardon. She is still a nurse, and I genuinely respect her, but if we are not  raising these matters on behalf of our constituents, we are failing in our responsibility as Members of Parliament. We must never forget that this is not just about the staff in our NHS; it is about patients and their safety, which must always be our absolute priority.

Luciana Berger: I am grateful to my hon. Friend for kindly giving way and for his important remarks. I echo his point that this is about patients across the country. My constituent’s mother, Angela, has been waiting for an acute mental health bed for more than a week. She was taken in an ambulance to A&E, but she could not be treated locally in Liverpool because it was full. She was treated for the physical effects of her mental health condition in an ambulance and sent home. Her family are devastated and are concerned about her condition. Her story is one of countless stories across the country, and we need to recollect and focus on those stories today.

Jon Ashworth: My hon. Friend speaks passionately, as she always does, on behalf of her constituents and, more broadly, on mental health provision. Again, I hope the Secretary of State will respond to her on the specifics of that case.
My hon. Friend talks about patient care, and she is absolutely right. All of us, or at least many of us, in this House will have been getting stories from constituents telling us of their recent experiences in hospitals. I have been given a few, and I will share some heart-breaking examples with the House. Again, I will not reveal the names of trusts and hospitals, but I will pass them on to the Secretary of State after the debate.
Example No. 1 is of a mum of four children under 10 years old who has a secondary tumour in her liver. She was due to go into hospital this Thursday to have the tumour removed. Her surgery has been delayed for at least two weeks so that the hospital could cope with the winter crisis and because no beds are available. She has not yet been given a new date.
Someone else got in touch with me this morning. Their wife has been on the waiting list for a knee replacement since April last year. An appointment for early December was cancelled owing to the hospital being on black alert. A few weeks later, the hospital phoned with an appointment for today, which was cancelled yesterday.
Again, these patients are not trying to score political points or to politicise matters. They are decent, hard-working people who are simply desperate for something to be done.

Helen Whately: Conservative Members care deeply about patients. I personally follow up on the individual stories and challenges experienced by my constituents, but the hon. Gentleman has surely seen the guidance this week from NHS Providers, which is not always a friend of the Government, that said that we need to be careful when extrapolating from individual incidents in hospitals that are under particular pressure and implying that they constitute a wider trend. Yes, times are tough in the NHS, and there are winter pressures, but he should not make inappropriate use of individual stories.

Jon Ashworth: The hon. Lady should be careful. I will be charitable, but she would not want to give the impression that she is dismissing the stories and examples that I am highlighting. NHS Providers has continually warned of the chronic underfunding of the NHS under this Government, and it has continually warned that, head for head, spending in this country will fall next year. If she wants to quote NHS Providers, she should quote all the facts from NHS Providers.

Stephen Doughty: My hon. Friend is telling some shocking stories. Was he as shocked as I was to hear Government Members shouting at and heckling the Leader of the Opposition during Prime Minister’s questions? They shouted, “What about Wales?” Does my hon. Friend agree that there  is actually a stark contrast in Wales? Welsh Labour is delivering 6% more funding than in England for the NHS and social care. We have brand new hospitals, including in my constituency, and an £80 million new treatment fund was announced yesterday to allow better access to treatments.

Jon Ashworth: My hon. Friend makes a powerful point about Wales. As a Member for Cardiff, he understands what is happening in the Welsh health service. I wish Conservative Members understood that better.

Kenneth Clarke: Will the hon. Gentleman give way?

Jon Ashworth: I will give way to the right hon. and learned Gentleman, but I will then make some progress.

Kenneth Clarke: Does the hon. Gentleman accept that every winter, for as long as I can recall, we have had a winter crisis in the NHS? It usually happens after Christmas. In winter the demands on the service become unpredictable, infections spread and the NHS starts losing staff. There are bound to be parts of the system that come under very real strain, and no one is trying to minimise the fact that they do. Apart from just producing this year’s crop of stories of very unfortunate incidents in various places, does he have any policy proposal at all, apart from simply spending more money wherever the reports are coming from?

Jon Ashworth: I am very grateful to the right hon. and learned Gentleman, who is a very experienced parliamentarian, for his intervention, but he will know that this is one of the worst winters for probably 20 years. He casually suggests that this happens every year, but I remember the years of a Labour Government when it did not happen. I remember the years of a Labour Government when we went further than the financial settlements he delivered as Chancellor of the Exchequer and were more than doubling the money going into the NHS—and tripling it in cash terms.

Several hon. Members: rose—

Jon Ashworth: If I may, I would like to make a bit of progress. I promise my hon. Friends, and indeed Conservative Members, that I will try to give way as much as possible, but I am very aware that many Members have put in to speak.
We are all becoming familiar—far too familiar perhaps—with the grim statistics: in December, 50 of the 152 English hospital trusts called for urgent action to cope with demand; the number of patients being turned away from A&E and sent to other hospitals is at a record high; A&E departments have turned patients away more than 140 times; and 15 hospitals ran out of beds in one day in December. Last night, the BBC revealed that leaked documents from NHS Improvement showed that there were more than 18,000 “trolley waits” of four hours or more; that almost a quarter of patients waited longer than four hours in A&E last week, with just one hospital—just one—hitting its target; and that since the start of December, hospitals have seen only 82.3% of patients who attended A&E within the four-hour target. We will return to the issue of the four-hour target in a few moments.
Ministers can try to deny what is going on but they cannot deny these facts about what is happening this winter in the NHS on their watch. We know that what happens in the NHS in the winter is a signifier of a wider crisis, because across the piece bed occupancy levels now routinely exceed the recommended maximum levels of 85%—often to levels higher than 95%. As I have said, the NHS is going through the largest financial squeeze in its history. Indeed the former Secretary of State, Lord Lansley, said that five years of NHS austerity had been planned for, but having 10 years of it was never expected. We have seen £4.6 billion cut from social care budgets—

Tom Pursglove: rose—

Jon Ashworth: I will give way in a moment. As the King’s Fund said, the reason there is a problem is quite simply because there is a
“mismatch between funding and activity”
affecting our hospitals. The response of Ministers, from the Prime Minister downwards, has been one of utter complacency. The Secretary of State told “Sky News” on Monday that things had only been
“falling over in a couple of places”.
When he came to the House on Monday to make his statement, he did not commit to extra emergency funding for social care and he did not promise that the financial settlements would be reassessed in the March Budget. It is worse than that, because while he was making his statement, his spin doctors were telling the Health Service Journal—this on the day when the winter crisis is leading the news and he is making a statement in the House—and letting it be known that there is “no prospect” of
“additional funding to support emergency care any time before the next election.”
So there is nothing for social care, nothing for emergency care, nothing to tackle understaffing and nothing to tackle underfunding—well thank you very much. What did we get as a response? We got a downgrade of the four-hour A&E target.

Jeremy Hunt: indicated dissent.

Jon Ashworth: The Secretary of State shakes his head and says, “Nonsense”, but let me remind him of what he said in the House on Monday:
“we need to have an honest discussion with the public about the purpose of A&E departments.”
He began by saying he wanted to provoke a discussion. He has certainly provoked a backlash, not least by blaming the public, it seems, for turning up at A&E departments.
He went on to say that the four-hour target
“is a promise to sort out all urgent health problems within four hours”,
but he added a little clarification, continuing:
“but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]
That is what he said in the House, and now we have seen the letter from NHS Improvement to trusts a few weeks ago, which talks of
“broadening our oversight of A&E”.
On the four-hour standard, it said that it believed
“there is merit in broadening our oversight approach, beyond a single metric”.
So in the interests of that discussion the Secretary of State wants to engage in, perhaps he can answer our questions, although I know he avoided the questions on Sky yesterday. Does he recall that in 2015 when he asked Sir Bruce Keogh to review these matters on waiting times, Sir Bruce said:
“The A&E standard has been an important means of ensuring people who need it get rapid access to urgent and emergency care and we must not lose this focus”?

Henry Smith: rose—

Jon Ashworth: I will give way in a few moments. Sir Bruce continued:
“I do not consider that there is a case for changing the 4 hour standard at this time.”
Does the Secretary of State still agree with Bruce Keogh? If he does, why did he make his remarks on Monday about needing to have a discussion about the future of the A&E standard?

Seema Kennedy: rose—

Jon Ashworth: I will give way in a few moments. If the Secretary of State wants to lead a discussion about the future of the four-hour A&E standard, will he tell us what discussions he has had with the Royal College of Emergency Medicine? It argues that the four-hour standard is a vital measure of performance and safety, and believes the standard should apply to at least 95% of all patients attending emergency departments. If he says he is still committed to that four-hour standard, is he still committed to maintaining it at 95%?

Rob Flello: Will my hon. Friend give way?

Jon Ashworth: My hon. Friend has had one bite of the cherry, so if he does not mind I shall make a little progress and then I will do my best to get as many people in as possible.
Does the Secretary of State agree—

Mark Harper: rose—

Jon Ashworth: I will give way in a few moments.
Does the Secretary of State agree that the four-hour standard is a reasonable proxy for patient safety? Does he agree that every breach of the four-hour standard can be regarded as a potentially elevated risk?

Seema Kennedy: rose—

Jon Ashworth: I will give way to the hon. Lady, as she has been very persistent.

Seema Kennedy: If the hon. Gentleman were to read the Government amendment, he would see that the Secretary of State says he “supports and endorses” the 95% target for A&E waiting times.

Jon Ashworth: I pay tribute to the hon. Lady for the work she is doing on tackling loneliness. I know that all Labour Members very much appreciate the work she is doing on that, along with my hon. Friend the Member for Leeds West (Rachel Reeves). The Government amendment is conspicuous in not referring to all patients.
The Secretary of State did distinguish between “urgent” and “minor”—[Interruption.] The hon. Member for Beverley and Holderness (Graham Stuart) says I should get a haircut. Did he say that? No? I beg his pardon, but he heckles so much it is sometimes difficult to hear what he is saying. Can the Secretary of State tell us how he would define the difference between “urgent” and “minor” care for instances relating to this four-hour standard? Can he tell us what will be the minimum severity of physical injury or other medical problem which will be needed for a patient to qualify for access to an A&E? How will we determine these new access standards? How quickly will they be available? Will patients with visible injuries be exempt from a new triage system? If so, which injuries will qualify? If the Secretary of State is not moving away from this four-hour standard, he needs to clarify matters urgently, because the impression has been given that he is doing so. [Interruption.] Not by me, but by his own remarks in the House on Monday. If he is not moving away from that standard, will he guarantee that he will not shift away at all from it throughout this Parliament and that it will remain at its current rate?

Mark Harper: rose—

Jon Ashworth: I will give way to the former Government Chief Whip.

Mark Harper: I, too, was in the Chamber on Monday and I listened carefully to the Secretary of State then. He was challenged by the right hon. Member for Exeter (Mr Bradshaw) on the target and was asked whether he was watering it down. He said explicitly that “far from watering down” he was recommitting the Government to it. He was generous to the Labour party in saying that it was one of the best things the NHS did. I think that was very clear.

Jon Ashworth: Let me say to the former Chief Whip that the Secretary of State said that
“we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]
The Secretary of State did not need to come to the House to make those remarks and set these various hares running, so the right hon. Member for Forest of Dean (Mr Harper) should make his objections not to me, but to the Secretary of State—

Several hon. Members: rose—

Jon Ashworth: I am going to move on a little.
If the Secretary of State is not abandoning the four-hour standard, as he insists he is not, we look forward to hearing him make that absolutely clear. He also said and has implied that we need to educate the public better so that they do not turn up at A&E departments. That was the implication of his remarks on Monday. Will he tell us how he is going to do that? What will be the cost implications of explaining to the public that they must not turn up at A&E departments? Are we expecting to see a large advertising campaign? Will the cost fall on local authorities’ public health budgets, which have already been cut? Will local authorities be given more resources for this new public education campaign?

Derek Twigg: My hon. Friend is making an important point. The key similarity is that back in 1997, when Labour took over, the health service was in crisis, and it is again today. Is not part of the problem that people are having to go to A&E because they cannot get in to see their GP?

Jon Ashworth: Absolutely. It is so difficult to get to a GP, which is why there are all these pressures on our A&Es. Of course, it is only going to get worse, because this year we are going to see cuts to community pharmacies—3,000 will be lost from our towns and streets because of the cuts that are being pursued. Let us not forget that the figure of 3,000 community pharmacies being lost was what the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told MPs.

Anne Main: Will the hon. Gentleman give way?

Jon Ashworth: I will give way one last time, but then I really must make some progress.

Anne Main: I led a debate in Westminster Hall this morning on pharmacies and integrated services in the NHS, and not one single Back-Bench Labour MP could be bothered to take part—not one!

Jon Ashworth: Labour MPs have been raising these matters in this House for weeks, including at urgent questions and in Opposition day debates.

Bill Esterson: I presume what the hon. Member for St Albans (Mrs Main) meant to say was that two Back-Bench Labour Members took part in the debate—I was one of them. Does my hon. Friend agree that the point about community pharmacies, GPs and investment in social care is that they save the Government money? That is why they should invest in them now to take pressure off A&Es.

Jon Ashworth: I thank my hon. Friend for correcting the record about that debate in Westminster Hall.
The Secretary of State denies that he is going to water down the A&E target; we welcome that, but we will watch carefully to ensure that he does not sneakily water it down throughout the remaining years of the Parliament. Will he tell us what he expects to happen next as we go through the winter? Weather warnings have been issued, and we could be heading for a cold snap. Will he update us on what urgent preparations he is putting in place to ensure that the NHS can cope? Is the NHS prepared for a flu outbreak, and what is his assessment of whether overstretched hospitals will be able to cope if there is one? It appears that, so far, Ministers have been burying their heads in the sand, but that will no longer do.

Lucy Frazer: My right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and my hon. Friend the Member for Lewes (Maria Caulfield) both made the point that the issues in the NHS are historical. On Radio 4 this morning the right hon. Member for Leigh (Andy Burnham) said he accepted that the previous Labour Government had not spent the right amount of money on social care. Will the hon. Gentleman accept that these issues are historical—they are not new—and that Labour does not have all the answers?

Jon Ashworth: The hon. Lady refers to history; under this Government the NHS is going through the largest financial squeeze in its history. When we had a Labour Government we more than doubled investment into the NHS.

Tom Pursglove: Will the hon. Gentleman give way?

Jon Ashworth: Because he is a Member from the east midlands, I shall give way to the hon. Gentleman from Corby.

Tom Pursglove: I agree with the shadow Secretary of State that we need to have an honest debate, so does he accept that he stood on a general election manifesto that would have seen Labour spend billions less on our national health service? Will he set out for the House exactly what NHS services he would be spending less on now?

Jon Ashworth: We stood on a manifesto that would have delivered more doctors and nurses for our NHS; the hon. Gentleman stood on a manifesto that said the Conservatives would cut the deficit and not the NHS. They are cutting the NHS and failing on the deficit.
I have a few direct questions for the Secretary of State about Royal Worcestershire hospital. I was grateful for his remarks on Monday, but I want to press him a little further. It has been reported that NHS England was warned of a bed crisis as early as 22 December. Will he update the House on what urgent meetings he is having on Royal Worcestershire? When will we be closer to knowing the outcome of an inquiry? In that context, there is a proposal in the sustainability and transformation plan for the Worcestershire area for a significant reduction in the number of acute beds. The Secretary of State will  say that these are local plans and so on, but in the context of the issues in Worcestershire, will he comment on whether he thinks that is the right proposal to follow?
On STPs more generally, the NHS is going through a winter crisis, and it is about to go through another top-down reorganisation—[Interruption.] Someone says it is bottom-up, but it is not; we know it is coming from the top. Those making the STPs are being told that they have to fill a financial gap of £21.764 billion—that is the reality that STPs throughout the country now have to face. We have seen the plans, so we know that that is going to mean a number of community hospitals being closed, a number of A&Es being downgraded, and acute beds being lost.
In places such as Devon, where the STP talks of an over-reliance on hospital beds, the implication is that beds will be lost. Closures and downgrades are being considered throughout Somerset, with their priority list of vulnerable services including maternity and paediatrics. In London, a city with the very worst health inequalities, the STPs are expected to deliver better health outcomes for the city’s growing 10 million residents with £4.3 billion less to spend. Will the Secretary of State explain to the House how he expects the NHS to perform in future winters, when we have a growing elderly population and STPs are pursuing multibillion-pound cuts to beds, A&Es and wider services?

James Heappey: I was recently briefed by an excellent and well-respected local GP and a clinical psychiatrist, who were the authors of our county’s STP. Will the shadow Secretary of State explain how on earth they are responsible for a top-down reorganisation?

Jon Ashworth: Because they were being told by NHS England, which was in turn told by the Secretary of State.

Neil Coyle: The right hon. and learned Member for Rushcliffe (Mr Clarke) mentioned infections spreading in the NHS. Does my hon. Friend share my concern about the infection that is spreading on the Government Benches? It is the infection of arrogance, complacency and being completely out of touch with the patients and their families who are suffering under the current crisis. We are witnessing inaction on an epic scale.

Jon Ashworth: My hon. Friend makes his point extremely well, although I would not want to be so mean about the Secretary of State—[Hon. Members: “Go on!”] No, I am not going to be mean about the Secretary of State.

Toby Perkins: In the past few moments, we have heard the ludicrous suggestion that Labour did not deliver on either spending or performance, but in fact our track record was excellent. That is not just my opinion; the former Prime Minister, David Cameron, said in 2011:
“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E, or months and months to have surgery done. So let me be absolutely clear: we won’t.”
He knew that Labour had a good record and that the NHS used to be good; why will these Tories not admit it?

Jon Ashworth: My hon. Friend makes a powerful point. Indeed, I remember, when we were in government, shadow Health Secretaries standing at this Dispatch Box opposing every penny piece of money that Labour was putting into the NHS. I remember a shadow Health Secretary, who now sits in the Cabinet as the Secretary of State for International Trade, standing at this Dispatch Box and saying that the A&E target was “indecent.” That was the Tories’ attitude when we were in government, so it is no wonder that we are sceptical about the Government’s intentions for the A&E target when we look at their history.

Henry Smith: The shadow Secretary of State is talking about the Labour record on the NHS; does he recall Labour closing not only maternity at Crawley hospital, but accident and emergency in 2005?

Jon Ashworth: I do not have the details of the Sussex STP to hand, but presumably if it contains any suggested closures the hon. Gentleman will be campaigning against them and knocking on the door of the Secretary of State, if those remarks are an indication of his point of view on these matters.

James Cartlidge: The hon. Gentleman is saying that everything was rosy under Labour, but he should remember that it was 10 years ago when the scandal at Mid Staffs broke, in which hundreds more elderly patients died than was projected. It was a terrible scandal and he should remember that. What our shadow team was doing at the time was holding the Labour Government to account.

Jon Ashworth: I take all deaths in hospitals seriously. My commitment to patient safety is unswerving. I will continue to raise matters, whether it is at Royal Worcestershire or elsewhere, but not in a partisan way with the Secretary of State—[Interruption.] I was not being partisan when I was asking questions about the Royal Worcestershire. The Government Whip, the hon. Member for Beverley and Holderness (Graham Stuart), really needs to calm down. I will raise these matters, because that is the responsible thing to do. It is unbecoming to play politics with patients in that way.
Culpability for the state that the NHS is in today lies at the door of Downing Street. The Government promised to protect the NHS and to cut the deficit, and they have not done so. The Government give away billion-pound tax cuts to corporations—[Interruption.] Yes, this Government. The Government waste billions, pushing the NHS in the direction of fragmentation and greater outsourcing while ignoring the ever-lengthening queues of the sick and the elderly in all of our constituencies.
Yesterday, we saw the Secretary of State on Sky losing his ministerial car and being chased down the street. It was his whole approach laid bare: not a clue where he is going; nothing to say; and not facing up to the problems. Last year, he blamed the junior doctors. On Monday, he blamed the patients. Today, he blames  Simon Stevens. Tomorrow, he will blame the weather. It is time that the Health Secretary started pointing the finger at himself and not at everybody else. The NHS is in crisis, and Ministers are in denial. I say to the Government, on behalf of patients, their families and NHS staff, please get a grip. I commend our motion to the House.

Jeremy Hunt: I beg to move an amendment, to leave out from “House” in line 1 to the end and add:
“commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government's support for the Five Year Forward View, the NHS's own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.”
I thank the shadow Health Secretary for bringing this afternoon’s debate to the House. He is right to draw attention to the pressures in the NHS, but, regrettably, I will have to spend much of my time correcting some totally inaccurate assertions that he has made, and that is a shame. This is an important debate for our constituents—for his and for mine—and for the NHS. The country deserves a proper debate, but that is difficult when we are given misinformation at a time when the NHS is under sustained pressure.
I am also very pleased to see the Leader of the Opposition in his place. I think that he has become rather a fan of my parliamentary appearances—[Interruption.] It is a Jeremy thing, he says—if only. I wish to address one part of my speech to him, because it is an area of policy for which he is perhaps more personally responsible.
Winter is always challenging period, and I want to repeat the thanks of the shadow Health Secretary and the thanks that I gave on Monday to NHS staff. According to NHS Improvement, on the Tuesday after Christmas the NHS had its busiest day ever. Earlier in December, it treated a record number of patients within four hours. Overall, as the Prime Minister said this morning, we are seeing 2,500 more patients within the four-hour standard every single day compared with what happened in 2010. As we discussed on Monday, the NHS made record numbers of preparations for this winter, because it is always a difficult time, including having 3,000 more nurses and 1,600 more doctors in full-time employment.
Let me address what the shadow Health Secretary said with regard to Worcestershire. I met colleagues from Worcestershire on Monday. A huge number of actions are now being taken, but we must say right up front that it is totally unacceptable for anyone to wait 35 hours on a trolley and that we expect the hospital to ensure that that does not happen again. There are plans in place to open additional bed capacity this week. We have already had capacity made available by Worcester Community Trust to support the flow. The trust has deployed its chief operating officer on the task of facilitating discharges. The trust is in special measures so we have a big management change, and a new chief executive will be starting later on in the spring.
What is wrong with what the shadow Health Secretary has just said is the suggestion that winter problems are entirely unusual. As my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) said, the NHS had difficult winters in 1999, 2008, and 2009. He remembers difficult winters from his time as Health Secretary, but there are things that are different today. One of them is that, compared with six years ago, we have 340,000 more over-80s, many of whom are highly vulnerable or have dementia. We know that when people of that age go to an A&E at this time of year, there is an 80% chance that they will be admitted to hospital.

Derek Twigg: The Secretary of State talks about correcting the points that have been made so that the House has the right information. May I repeat the question that I asked him on Monday? What are the latest figures—he should have them up to this week—for the number of people who could be discharged but have to remain in hospital because there is no community support available for them? Can he give us that figure now? He said that he would write to me, but he must know that figure now.

Jeremy Hunt: Last year, on average, it involved around 7,000 beds, which is far too many. That is why the Secretary of State for Communities and Local Government announced in December a new package of support worth around £400 million—

Derek Twigg: rose—

Jeremy Hunt: Let me answer the hon. Gentleman’s question. I said that I would write to him, and I will do so. He may have noticed that there are other issues that we are dealing with, which is why I may not have had time to sign the letter. The £400 million extra for local authorities over the next two years will make a significant difference and he should recognise that.

Richard Fuller: I am attending this debate because there will be constituents in Bedford and Kent who are concerned about the headlines that they have read. I am pleased that the Secretary of State will correct some of the points that have been made. What our constituents want to know is what is being done, or what should be done. I listened for 33 minutes to the shadow Secretary of State—the Labour spokesman on the NHS—on this issue, and there was not a single new idea other than spending money. Will my right hon. Friend please provide some practical answers to the problems that are being raised in the papers?

Jeremy Hunt: My hon. Friend is absolutely right, which is why I will be talking later about our solutions to these problems.

Several hon. Members: rose—

Jeremy Hunt: I will give way, but first I want to make some progress.
I want to talk about something else that is different in our A&E departments today compared with six years ago. Although we are sticking to the four-hour target, we also insist on much higher standards of safety and quality.
On Monday, I congratulated Labour on the introduction of the four-hour target—I support it—but we should also remember that four years after that standard was introduced, we started to see some horrific problems at Mid Staffs, many of which were in the A&E department. Some were caused because people thought they would be fired if they missed the target. Robert Francis said that the failures at Mid Staffs were
“in part the consequence of allowing a focus on reaching national access targets.”
Therefore, although we retain targets, we will not allow them to be followed slavishly in a way that damages patient care.

Derek Twigg: Will the Secretary of State give way?

Jeremy Hunt: I have already given way to the hon. Gentleman. There are many other Members who want to intervene.
That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control, and ambulances were being used as waiting rooms.

Toby Perkins: I am grateful to the Health Secretary for outlining some of the steps that he is taking in the face of this immediate emergency. Does he also recognise that the major cause of the problems in A&E is simply a lack of staff? Consequently, does he regret the huge cuts to training budgets in 2010, 2011 and 2012, which are having a real impact now on the number of nurses and doctors in our NHS?

Jeremy Hunt: I agree that staff numbers are critical, but we have, since 2010, 1,500 more doctors in our A&E departments and 600 more consultants. Across the NHS, we have more than 11,000 additional doctors, so we do recognise the pressures that the NHS faces. Indeed, we have 1,600 more doctors than this time last year, so we are doing a great deal to solve the problem.

Graham Evans: Does my right hon. Friend agree that we need to learn best practice in the NHS? The hospitals that manage to integrate health and social care, such as those in Wigan and Salford which have managed to create those beds, are providing examples of best practice from which the whole of the NHS can learn.

Jeremy Hunt: My hon. Friend is absolutely right. It is a mistake in this debate to try—as I understand Opposition parties want to do—to boil this all down to the issue of Government funding when there is actually a lot of variability in the country. At this time of year, which is always difficult, some hospitals are doing superbly well in extremely challenging circumstances. We have just heard about some of the hospitals that are doing well, and there are a number of them.

Several hon. Members: rose—

Jeremy Hunt: I will give way to as many people as I can, but I also want to address the substantive points made by the shadow Health Secretary. He talked about the four-hour target. In his motion and his speech, he made  the totally spurious suggestion that we are not committed to that target. I remind him of what my right hon. Friend the former Chief Whip quoted me as saying on Monday. I did not just commit the Government to the target; I said that it was one of the best things that the NHS does. However, I also said that we need to find different ways to offer treatment to people who do not need to be in A&E. It is hardly rocket science. When there is pressure in A&E, it is sensible—indeed, I would argue that it is the duty of the Health Secretary—to suggest that people who can relieve pressure on A&E by using other facilities do so.

Henry Smith: Just yesterday at Crawley hospital, an acute care unit was opened, which is designed precisely to ensure that people who do not need to attend A&E are properly directed to the most appropriate care, which is good for them as individual patients and good for the whole system.

Jeremy Hunt: That is absolutely right. To back up my hon. Friend’s point, yesterday’s OECD report said that in Australia, Belgium, Canada, France, Italy and Portugal, at least 20% of A&E visits are inappropriate. NHS England’s figure is up to 30%, which is why we need the public’s help to relieve pressure and that is what I meant when I talked about an honest discussion.

Luciana Berger: The Secretary of State told us just a moment ago that there are now over 300,000 more people over the age of 80. Surely he would have known that information from census and Office for National Statistics data when his Government took over seven years ago, so why is it that we are now seeing on the front pages of our newspapers that one in four of our A&E wards is unsafe and that we have so many challenges across the country, including in my constituency?

Jeremy Hunt: We did know that information and that is why we thought it was totally irresponsible to want to cut the NHS budget in 2010, and not to back the NHS’s own plan in 2015. As a result of that, we have 11,000 more doctors. In the hon. Lady’s local hospital, 243 more people are being treated within four hours every single day.

Owen Smith: rose—

Jeremy Hunt: I will make some progress and then give way. I could have put what I said on Monday another way. I could have said:
“We have to persuade those people not in medical emergencies to use other parts of the system to get the help they need”.
I did not actually say that, but I will tell you who did. It was the then Labour Health Minister in Wales, Mark Drakeford, in January 2015. Frankly, when the NHS is under such pressure, it is totally irresponsible for the Labour party to criticise the Health Secretary in England for saying exactly the same thing that a Labour Health Minister in Wales also says.

Owen Smith: Will the Secretary of State give way to a Welshman?

Jeremy Hunt: I would be privileged and honoured to give way to a Welshman.

Owen Smith: The Secretary of State has sowed confusion in the House and in the country on this question this week, and he is doing so again today. If he is saying the same as my friend the former Health Minister in Wales—that we want to divert people who do not need to go to A&E from doing so—I am sure that everybody in this House would support him. But we suspect that he is saying that the four-hour wait target will be disapplied to some people turning up to A&E, and that that is the downgrading he is talking about. If that is the case, the Secretary of State should come clean, and he should be clear about whose job it will be to disapply the target to some people with minor ailments.

Jeremy Hunt: I did not say that because we are not going to do it. As we have had an intervention from a Welshman, let me tell the hon. Gentleman a rather inconvenient truth about what is happening in Wales. Last year, A&E performance in Wales was 10% lower than in England, and Wales has not hit the A&E target for eight years. We will not let that happen in England.
I noticed that the shadow Health Secretary quoted a number of people, but one that he did not quote was the Royal College of Emergency Medicine. I wonder if that was because of what it said about Wales this week. It said:
“Emergency care in Wales is in a state of crisis…Performance is as bad, if not worse, as England, in some areas.”
There we have it: in the areas in which Labour is in control, these problems are worse.

Several hon. Members: rose—

Jeremy Hunt: Let me make my point. I do not say that to make a political point, but to show that it is patently ridiculous to try to play politics when there are winter pressures in the NHS. This happens in the whole NHS—in Wales as well as in England.

Several hon. Members: rose—

Jeremy Hunt: I want to make some progress but I will give way to my hon. Friend the Member for Lewes (Maria Caulfield), who is a serving nurse.

Maria Caulfield: May I reiterate the Secretary of State’s point about the four-hour target? During the Labour Government, I was working in the NHS. Significant pressure was put on us by managers to meet the four-hour target, negating clinical need. Patients were often prioritised according to meeting the target, rather than by clinical need. That was a disgrace.

Jeremy Hunt: That is exactly the problem we had with Mid Staffs. We had a culture in the NHS where people were hitting the target and missing the point. Although targets are important management tools in all organisations, it is important that they are followed in a sensible way that puts the interests of patients first.

Several hon. Members: rose—

Jeremy Hunt: I would just like to make another point about Wales while we have the privilege of having someone here who aspired to lead the Labour party, as the current leader of the Labour party is no longer in his place.
Something that Wales and England have in common is the need to ensure that, if we want alternatives to A&E, people are able to see their GPs. I have said many times that people wait too long to see their GPs. In all honesty, I think that the GP contract changes in 2004 were a disaster. The result was that 90% of GPs opted out of out-of-hours care. But we have been putting that right. Now 17 million people in England—about 30% of the population—have access to weekend and evening GP appointments. More than that, we have committed to a 14% real-terms increase in the GP budget by the end of this Parliament. That is an extra £2.4 billion and we expect that to mean an extra 5,000 doctors working in general practice.

Margaret Greenwood: I can see Wales from my constituency, to continue the theme. I received an email this morning from a very distressed senior NHS manager, who says:
“I truly despair that there will not be an NHS this time next year”—[Interruption.]
You need to listen on the Government Benches, and understand what your Secretary of State is doing to the health service. I will give a precis of what my constituent is talking about.

Natascha Engel: Order. The hon. Lady will resume her seat. First, when she says “you”, she is addressing the Chair. Secondly, she is making an intervention. There are 33 Members who wish to speak in this very important debate. If she can keep her intervention very brief, I will let her continue.

Margaret Greenwood: Apologies, Madam Deputy Speaker. I should not have used the word “you.”
My constituent has written to me saying:
“The NHS is in crisis, the government knows this, CCGs have failed, foundation trusts are failing. GPs are on their knees. So they’re”—
the Government—
“handing it back to local areas and saying, ‘you fix it, and by the way there’s no money.’ It’s a whole system reorganisation”,
and there is no money.

Jeremy Hunt: All I would say is that I hope that people in the NHS do not listen too much to what the Labour party says about the state of the NHS and that they listen to what the Government are saying, which gives a much more accurate picture as I will go on to explain.

Neil Coyle: Will the Secretary of State give way?

Jeremy Hunt: I will make some progress before giving way again.
The second part of the motion talks about funding. There is no doubt at all that we will need to look after 1 million more over-65s in five years’ time and we will need to continue to increase investment in the NHS and social care system. That is happening with an extra £3.8 billion going into the NHS this year. Can I just remind Labour Members that that is £1.3 billion more than they promised when they stood for election last year? I just say this: it is not enough to talk about extra funding—you have to actually deliver it. Labour Members have to answer to their constituents as to why, for two elections in a row, they have promised less money for  the NHS than the Conservatives, and why, in the one area where they are responsible for the NHS, they have cut funding.

Julian Knight: The Secretary of State is taking exactly the right, measured tone, which was absent earlier in the debate. We recognise that many trusts are under financial pressures, but some of these situations are historic, and in my area they reflect very poor private finance initiative contracts, which were thrust on them in a Gordon Brown sleight of hand.

Jeremy Hunt: My hon. Friend is right. What we did not hear from the Labour party is that, in 2010, we inherited a £70 billion PFI overhang, which is making it incredibly difficult for hospitals to recruit enough staff, because they are having to pay so much money to financiers.

Victoria Atkins: An example of how we are spending money practically on the ground to make sure patients get a better deal is in Lincolnshire, where, because there is a shortage of GPs, the local health authority is offering £20,000 as a golden hello to new GPs. Is that not the way to manage resources, to attract the best medical talent into our areas and to help ensure that patients get the best care?

Jeremy Hunt: My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.
It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.

Norman Lamb: I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?

Jeremy Hunt: I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.
However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.

Several hon. Members: rose—

Jeremy Hunt: I will give way on funding one more time.

Mark Harper: We had the debate at the election about the need for a strong economy to pay for the NHS, and the public decided that the Conservative party won that argument. May I give my right hon. Friend another example, from yesterday, from his friend Jeremy—the Leader of the Opposition? He proposed to cap high pay, but the top 1% of taxpayers pay 27% of income tax revenues. That proposal would cut the funding available to the NHS and damage the services that hard-working members of staff produce.

Jeremy Hunt: My right hon. Friend is right. That is the worst kind of gesture politics, because it may get the Leader of the Opposition a few votes or a few more Momentum supporters, but it would damage the NHS.

Helen Whately: Does my right hon. Friend agree that Opposition Members, rather than making meaningless and totally unfunded promises of more money for the NHS, contrary to their manifesto back in 2015, would do better to recognise demographic changes, such as the ageing population, and the need for the NHS to change, and support the locally developed plans for change in the national health service—the sustainability and transformation plans?

Jeremy Hunt: My hon. Friend is absolutely right. I think people in the country will find it hugely ironic that the party that spent so much energy in the last Parliament campaigning against top-down reorganisations is now campaigning against locally driven changes.

Several hon. Members: rose—

Jeremy Hunt: I will give way a couple more times, and then I am going to conclude my comments.

John Woodcock: As the Government often point out, they want to hand decisions to local groups, but could the Secretary of State explain to worried patients in the south and west of Cumbria why local health services are suggesting the changes to A&E in the west and potentially the south? I know he has spent a lot of time looking at this area.

Jeremy Hunt: First, I would like to use this moment to congratulate the hon. Gentleman’s local trust on coming out of special measures last year and on the progress it is making. In a way, that is the answer to his point. His local trust was in special measures, and North Cumbria is still in special measures. We had some profound worries about patient care in both trusts, and we still do in the North Cumbria trust. That is why the status quo  is not an option, but we understand the concerns of his constituents and many others about some of the proposals being made.

Catherine West: What does the Secretary of State make of the talk among professionals at the moment about the potential for a flu epidemic? What does he make of the comments by the doctor who wrote to me on Sunday saying that she is extremely concerned that staff are too busy to isolate patients who are coming in—who need oxygen—in order that others do not potentially catch flu?

Jeremy Hunt: There is a concern at the moment about a growth in respiratory infections, and that is causing capacity constraints. We are watching what is happening on flu very carefully, but we have a record 13 million people vaccinated against flu, and I hope that that will put the NHS in a good position.

Robert Jenrick: Money is of course important, but may I support the Health Secretary in not viewing these issues solely through that lens? My local trust, Sherwood Forest, which has some of the worst finances of any trust in the country—almost all due to a PFI deal signed by Gordon Brown—is actually improving. It is under pressure this winter, but the management have said it is definitely not in crisis. That is an example of a trust improving due to quality management, reform and good-quality processes.

Jeremy Hunt: That is absolutely the point, and the last point I want to make before concluding on funding is that we miss a trick—I think the shadow Health Secretary is in some ways more reasonable than his leader on these issues, which is probably terminal for his career—if we say that this is just about money. We forget the debate we went through on schools in this country 20 years ago, when there was, again, a debate about money, but we realised that the issue is actually also about standards and quality. That is what has happened in Sherwood Forest, and I congratulate the trust. It is important that we do not let debates about funding eclipse that very important progress that we need to make on standards.

Tania Mathias: rose—

Jeremy Hunt: I am going to conclude now because lots of people want to come in, I am afraid.
The shadow Health Secretary’s central claim—these are his words—was that the culpability for what is happening in the NHS “lies at the door of Downing Street”. I owe it to the country and this House to set the record straight on this Government’s record on the NHS. It is not just the fact that there are 11,000 more nurses and 11,000 more doctors; not just the fact that, on cancer, we are starting treatment for 130 more people every single day, and have record cancer survival rates; not just the fact that we have 1,400 more people getting mental health treatment every day and some of the highest dementia diagnosis rates in the world; and not just the fact that we are doing 5,000 more operations every day and that, despite those 5,000 more operations every day, MRSA rates have halved. We have an NHS with more doctors and more nurses, and despite difficult winters, with patients saying they have never been treated more safely and with more dignity and more respect.
Next year the NHS will be 70 years old. This Government’s vision is simple: we want it to offer the safest, highest quality care anywhere in the world. When we have difficult winters and an ageing population, of course that makes things more challenging, but it also makes us more determined. It means that we are backing the NHS’s plan, it means more GPs and better mental health provision, and it means an NHS turning heads in the 21st century just as it did when it was founded in the 20th century.

Philippa Whitford: Here we are again debating the NHS. [Interruption.] I am all on my own because obviously this is predominantly a crisis in NHS England, not a crisis in NHS Scotland, as I will discuss as we go on.
The problem is that we are talking about patients who are suffering—who may suffer from more infections, as we have heard. We are talking about staff who are in tears and who are desperate, and who feel that they cannot deliver the care they would expect to deliver. This is not just a matter of isolated stories of “Joe from Wiltshire” and “Mike from Leeds”: it is happening on a major scale. We hear from NHS Improvement that only one trust out of 152 met the four-hour target in December, and only nine made it to over 90%. Fifty out of 152 trusts declared a black or red situation over December, and there were 158 diversions of ambulances over that time. This is not just about normal winter pressures. It is not what the hon. Member for Lewes (Maria Caulfield), who is an A&E nurse, and people like me and other medics in the Chamber have seen in our careers—it is a really bad winter. Yet we have not had bitter weather and we have not had a flu epidemic.
The most recent four-hour data were published in October, when NHS England managed to achieve the four-hour target for 83.7% of the time. That is 5% down on the same time in the previous year, and it compares with 93.9% in Scotland. Scotland managed 93.5% in Christmas week. We have our challenges in Scotland, but the crisis is not the same as what is being discussed here.

Simon Burns: Will the hon. Lady confirm, though, that throughout the whole of 2016, which includes winter, summer, autumn and spring, the Scottish Government’s A&E target was met in only seven out of the 52 weeks?

Philippa Whitford: I would be delighted to agree with that, but NHS England did not make it over 90% at any point in 2016, so perhaps the right hon. Gentleman might want to check the NHS England figures before having a punt at me.
NHS England is performing 8% to 10% lower than NHS Scotland, which has been the top performing of the nations for the past 19 months. We have not done that by magic. We face exactly the same ageing population, exactly the same increased demand and complexity, and exactly the same—indeed, often worse—shortages of doctors as NHS England does, because of our rurality. We are not using a different measure—we use exactly the same measure—but the data show that there is a significant difference, and it is being maintained.
The Secretary of State is right: winter is always challenging. Summer is often busier for attendances at A&E, because the kids are on the trampolines and people go out and do silly things, but hospitals are under pressure in winter because of the nature of admissions—the people who go to A&E are sicker, older, and more complicated. However, we have not seen any summer respite in NHS England. The worst performance in the summer was 80.8%; the best was 86.4%. NHS England is under pressure in the summer, and when winter is added on top of that, it is no wonder that we are talking about the situations that doctors, nurses, patients and relatives are describing to us.
My first health debate after my maiden speech in this House was an Opposition day debate on the four-hour target. At the time, I commented, and still maintain, that this target is not a stick for each party to hit each other over the head with, but it is a thermometer to take the temperature of the acute service, and it does that really well, because it measures not just people coming in through the front door but how they are moving through the hospital and out the other end. At the moment, the system is completely overheated. The comments about this not being anything unusual but just a normal winter, and everyone whingeing, show that the Government are not recognising the problem. The first step to dealing with any problem is to recognise it, because then we can look at how we want to tackle it.

Victoria Atkins: I remind the hon. Lady of the point the Prime Minister made in Prime Minister’s Questions, which is that on the Tuesday after Christmas, A&E received the highest number of visitors it has ever received in its history. Does that not show the challenges facing the NHS both nationally and locally? These are extraordinary figures, and the Secretary of State is very much doing his best to help the NHS, with the professionals, to deal with them.

Philippa Whitford: I totally accept that the NHS has been under inordinate pressure with, absolutely, the busiest day in its history, but given an ageing population that has been discussed for years, we should have been able to see this coming.
If, in the next couple of months, we get a massive flu epidemic, we are going to see things keel over. We have already had debates in this Chamber about STPs taking more beds away. I totally agree with the Secretary of State that part of the issue is that patients could be seen somewhere else. However, it is not a matter of changing the four-hour target and saying to someone who turns up, “You’re not going to count”; it is simply a matter of providing better alternatives. If we provide better alternatives, people will go to them. The House has discussed community pharmacy use, and it has been recognised that the minor ailments services we have in Scotland can deal with 5% to 10% of those patients. We have co-located out-of-hours GP units beside our A&Es, and that means that someone is very easily sent along the corridor or into the next-door building if they need a GP and not an A&E. We do need to educate the public, but the public will use an alternative service if it is there. If it is not, they know that if they turn up at A&E and just keep sitting there, eventually someone will see them, and we should not blame them for that.

Toby Perkins: The hon. Lady is right to say that we have an ageing population but that is predictable. Does she think it is also significant that in 2008 the UK was spending about the same as all the major EU nations, whereas the OECD now says that we are spending considerably less than most of the other major nations? Is that not actually causing this problem?

Philippa Whitford: Money is not the only problem. I accept that part of it is about how things are done. The Secretary of State talks about variations and many hospitals performing well, but, as I said, only one trust is meeting the target and only nine are at over 90%, so it is not that the majority are doing well and a few are failing.
The ability to look at how we deliver the NHS is crucial, but change costs money. We must therefore invest in our alternatives so that our community services and primary care services can step up and step down to take the pressure off. One of the concerns about the STPs is that because people do not have enough money, a lot of them start by thinking that they will shut an A&E, shut a couple of wards, or shut community beds—even though those are what we need more of—to fund change in primary and social care. Then the system will fall over. We need to have double running and develop our alternatives and then we will gradually be able to send the patients there.

Andrew Murrison: I always enjoy listening to the hon. Lady’s well-informed remarks. I agree that most people do not want to go to A&E if they can avoid it. Does she agree that part of the problem is that when people phone general practices, they tend not to be offered an appointment that they regard as being within a reasonable timeframe, or they cannot get to see the doctor with whom they are closely associated, which particularly applies to people with chronic and long-term conditions? As today’s National Audit Office report makes clear, we need to address that as a matter of urgency. Paradoxically, seven-day-a-week general practice may militate against being able to provide people with such continuity of care during core hours.

Philippa Whitford: Many doctors in general practice would accept the argument for having access to a GP on Saturday morning, particularly for people who are otherwise at work. However, someone who cannot see their favourite doctor is very unlikely to go to A&E and wait eight hours to see a doctor they have never seen before in their life. This is not about that; this is about the fact that people feel they cannot find an alternative. If it takes three or four weeks to get any appointment with their GP and they do not yet have a community pharmacy offering such a service, they will eventually end up at A&E. It is therefore the service of last resort for people who go there and just stay there. We have to develop alternatives first, but as the hon. Gentleman says, no one in their right mind would choose to go and wait four hours in A&E if they could be seen in half an hour in a community pharmacy.

Andrew Murrison: The hon. Lady is being very generous in giving way. I have to disagree with her, because winter pressures and the pressures we are seeing at the moment tend to involve not people with short-term, self-limiting  conditions, but the chronically sick. Those people in particular, and with good reason, want to have a relationship with a particular practitioner who understands their needs and their family context. That is surely the essence of general practice.

Philippa Whitford: I totally agree, but in fact the chance that their doctor will be on duty would actually be lower on a Saturday morning or a Sunday afternoon. One of the things we have done in Scotland with SPARRA—Scottish patients at risk of readmission and admission—data is to identify that 40% of admissions involve 5% of the patients. Those patients are all automatically flagged and will get a double appointment no matter what they ring up about, because it will not just be a case of a chest infection or a urine infection, but of having to look at all their other comorbidities.
That is the challenge we face; it is not a catastrophe of people living longer. All of us in the House with a medical background will remember that that was definitely the point of why we went into medicine, and it is the point of the NHS. However, we are not ageing very well. From about 40 or 50 onwards, people start to accumulate conditions that they may not have survived in the past, so that by the time they are 70 they have four or five comorbidities that make it a challenge to treat even something quite simple. My colleagues and friends who are still working on the front line say that it is a question not just of numbers, but of complexity. Someone may come in with what sounds like an easy issue, but given their diabetes, renal failure and previous heart attack, it is in fact a complex issue.
That is part of the problem we face, and we need to look forward to prepare for it. We need to think about designing STPs around older people, not around young people who can come in and have an operation as a day case and then go away, because that is not what we are facing. Older people need longer in hospital, even medically, before they reach the point of being able to go home. It takes them a couple of days longer to be strong enough to do so. They probably live alone and do not have family near them, so they will need a degree of convalescent support and they may need social care. That is really where the nub of the problem lies. Social care funding has gone down, and therefore more people are stuck in hospital or more people end up in hospital who did not actually need to be there in the first place.

Andrew Selous: On the frailties of older people, does the hon. Lady think that just as Scotland led the way with St Ninian’s primary school in Stirling introducing the daily mile, there is something we could learn from countries, such an Andorra, that have a real focus on exercise for older people, so that they are a lot less frail in their 70s and 80s?

Philippa Whitford: The whole prevention and public health message is crucial, and that is one of our other challenges. I am very grateful to the Secretary of State for no longer talking about a figure of £10 billion, because the increase in the Department of Health’s budget is actually £4.5 billion. Part of that relates to the reduction in public health funding, just at a time when we need to move it on to a totally different scale. Whether that is children or, indeed, adults doing the daily mile—perhaps we should run up  to Trafalgar Square and back every lunchtime, which I am sure would do all of us a power of good—we need to invest in such preventive measures. One of my points is that when we end up desperate—patching up how the NHS runs, or dealing with illnesses we did not bother to prevent—we always end up spending more money.

Graham Evans: The hon. Lady knows how much I respect her and what she says. As the chairman of the all-party group on running, I endorse the daily mile and encourage all adults to do it. Park runs, which happen across the nation, are a good example. There is huge expertise in Scotland, so can NHS England learn from Scotland? What is best practice, and will she give us some examples of it in hospitals and hospital trusts in Scotland that we can take away and learn from?

Philippa Whitford: The whole issue comes down to sustainability, which is obviously the idea behind the sustainability and transformation plans. As those who have heard me speak about STPs will know, I support the idea in principle. The idea is to go back to place-based planning on an integrated basis for a community. The difference in Scotland is that we have focused on integration. We got rid of hospital trusts in 2004, and we got rid of primary care trusts in the late 2000s—in 2009 or 2010. Since April 2014, we have set up integration joint boards, where a bag of money from the NHS and a bag of money from the local authority are put on the table and a group sit around it and work out the best way to deal with the interface and to support social care. Anyone in the Chamber or elsewhere with family members who have been stuck in hospital will know that people get into a bickering situation: Mrs Bloggs is in a bed so the local authority is not interested, because she is safe there, and the local authority is instead busy with Mrs Smith, who has fallen off a ladder trying to put up her curtains and who is not considered safe because she is leaving the gas on. Such boards get rid of all that perverse obstruction.

David Rutley: The hon. Lady is making an important point, and I welcome the tone that she, unlike the shadow Secretary of State, has brought to this debate. She makes the point that the integration of care—social and health—is important, but does she agree that, with further devolution to the sub-regions and major cities in England, there is a huge opportunity to move forward that agenda south of the border?

Philippa Whitford: The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, which means that is a waste of layers, and it will be very difficult to integrate.
One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between  £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.
As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals, we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

Victoria Prentis: Much of what the hon. Lady says is music to my ears as somebody who is campaigning to save their local general hospital. May we have the benefit of her views on the role of consultation with patients and the wider community when sustainability and transformation plans are being considered?

Philippa Whitford: Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.
Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.
I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

Jo Churchill: I thank the hon. Lady for, as ever, eloquently expressing issues that face all of us, no matter where we come from and who we are. Does she agree that having good healthcare data for clinicians enables patients to be put through the system seamlessly? Many individuals do not realise that their data do not go from their GP into acute care and then back into social care. If we could improve that—I make a plug for my private Member’s Bill on Friday—it would help patients.

Philippa Whitford: I would not say that we are super IT wizards in Scotland, but we did not get involved in care.data, which unfortunately is a black shadow over the whole issue of NHS data in England, and now all our referrals are electronic, so nothing goes in the post. All our letters back are also electronic—I dock my dictation machine during a clinic, and when I finish I sit and check it, and the letters go off. After a Friday morning bad news clinic, the letters are on their way by 2 o’clock. A GP can email my colleagues and say “I don’t know whether you need to see this person.” I have heard clinicians here in England say, “No, we can’t email about a patient.” Unfortunately, the wrong move that was made on care.data has ended up holding people back.
Our GPs in Scotland use a care summary. If they have a palliative care patient who has been accepted as being in terminal care, that patient’s care summary will be put on the out-of-hours system. That means that if there is a call about the person, the doctor who goes to see them knows that they will not be throwing them in an ambulance but will be keeping them comfortable. The discussion has already been had, and the aim is for them to be at home. England has to gain the ability not just to analyse data at a later point but to share information as a first step.
In finishing off my speech—[Interruption.] I am sorry if I was taking too long for an hon. Lady at the back of the Opposition Benches. Integration is the key, and it is possible to get it through the STPs—but only if they are designed around patients, safety and services rather than just starting with the bottom line and working backwards.

Several hon. Members: rose—

Eleanor Laing: Order. Before I call the next speaker, it will be obvious to colleagues that a great many Members wish to speak this afternoon and that although the debate has advanced a long way in time, it has not advanced very far in the number of Members called. We therefore now have to have a time limit of 10 minutes. [Interruption.] I can see that there is some surprise about that; it is 10 minutes for the moment, but anyone who can do any arithmetic will be aware that it will have to be reduced later, so I suggest that Members start working on their speeches now.

Sarah Wollaston: I will try to be mindful of those comments, Madam Deputy Speaker, as I follow the hon. Member for Central Ayrshire (Dr Whitford), my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.
First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour  target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients’ experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.
The Secretary of State is also right that we sometimes need to be more nuanced about our targets, and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them, and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.
We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.
I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.
Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.
I welcome the Prime Minister’s focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the “burning injustice” of health inequality. We in this House have a role in doing that together in a consensual manner.

Norman Lamb: I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister’s response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House, and my hope that it might start a more constructive approach?

Sarah Wollaston: Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

Barbara Keeley: I wonder, on this vital issue, whether the hon. Lady wants to say something about what her own party did on the  two previous times we tried to get important cross-party working on health and social care: it made it an election issue, producing posters about a “death tax”; and on the second occasion the Secretary of State just walked away from the talks.

Sarah Wollaston: I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady’s comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

Jim Cunningham: Looking to the future, does the hon. Lady not agree that there should be a new funding settlement for the NHS and social care budgets that brings both together? At the moment, there have been cuts of £4.6 billion.

Sarah Wollaston: That is exactly what I am hoping. We must end the silos of health and social care. We should stop thinking about money as a social care pound or a health pound, and instead think about a patient pound and a taxpayer pound, and how we get the very best from that.
That brings me on to a point I would like to raise directly with the Secretary of State. There is an example of where this has happened: in my constituency, Torbay and South Devon NHS Foundation Trust has formed an ICO—an integrated care organisation. Across health and care, passionate people recognised the benefits and sweated blood to get the organisation off the ground. Torbay’s integration is talked about not just nationally but internationally as a recognised way of doing this better. I regret to say, however, that because of the scale of the financial pressure on the ICO, we are now hearing that next year the NHS will be pulling out of the risk-sharing agreement.
That is totally unacceptable. I hope the Secretary of State will meet me to discuss the particular pressures facing the ICO, which has achieved exactly what we are talking about in this debate. It is able to pool finances better through risk-sharing and to work together to get people out of hospital who do not need to be there more rapidly than happens in other areas. It can put people from social care into hospitals to see how we can speed up that process. Unfortunately, if that risk-share falls apart, one of the key pillars of how we want to improve the flow through hospitals and out the other end will break down. Part of the reason, as I understand it, is that unless the control totals are met the funding it hopes to use to improve the facilities in the A&E department will be at risk. The challenge for Torbay is not how it works together to get people out of hospital; it is the facilities at the front door, and it could do so much to improve the facilities. We have the odd paradox whereby we could end up improving A&E infrastructure but worsening the ability of the system to respond at the point where we are trying to get people cared for in the community.
A certain degree of financial challenge can have the effect of bringing health and social care organisations to work more closely together because they know it makes sense, but when unrealistic targets are set it can go the other way. It can start to mean that people have to retreat to protect their budget silos. I hope the Secretary of State will closely at what is happening and meet me to discuss whether we cannot just get this back on track for next year. I am confident that the local authority and the NHS staff across the CCG and the provider trust will continue to work together—they have an extraordinary tradition of doing so—but there are threats, which I hope can be addressed. This is about the entire flow from the front door right the way through to getting people cared for back at home.
More widely, we now have more than 1 million people in communities who are unable to receive the care they need. Mears, the prime provider in my area, is in special measures. These are financial issues. Yes, there is much that the NHS can do that is not about money—we know there is a lot of variation that cannot be explained by financial challenge and demographic changes alone—but finance and the workforce inevitably are the key challenges we have to face, and we have to work together across all political parties to resolve them.
In closing, I would like to raise with the Secretary of State the front page of today’s The Times, which is extraordinarily disappointing. This is the second time a major national newspaper has reported briefing against the chief executive of the NHS, Simon Stevens. I invite the Secretary of State or the Minister closing the debate unequivocally to support the chief executive of the NHS. When the chief executive appears before the Health Committee and I, as the Chair of the Committee, ask him to respond to questions, I expect him to be truthful and transparent in his answers. He should be commended for doing so and not find himself the subject of negative briefings. I therefore invite the Minister unequivocally to support him and ask for this to stop.

Rosie Winterton: The debate so far has shown the huge level of concern from the public and NHS staff about the crisis in the NHS and social care. The hon. Member for Totnes (Dr Wollaston) reflected some of the views of the Select Committee, but I ask all Government Members to take those concerns seriously and not to dismiss them. All hon. Members must surely be receiving representations from staff and patients about what is happening locally.
I want to pay tribute to all the health and social care staff in Doncaster, in particular those at Doncaster Royal Infirmary whose work I have seen at first hand. I know how dedicated and committed they are to caring for patients in these most difficult of circumstances. At the end of December, they had managed to achieve 90% against the 95% target and had good ambulance handover times, as well as good support from the council and community partners, but they are facing real pressures and they are fearful about the pressures still to come, especially if, as predicted, there is a cold spell. That is why the mixed messages from the Secretary of State have been extremely damaging.
I was a Health Minister for four years and had responsibility for emergency care. I know how important it is to work with NHS staff to help to implement  targets, and not to give the impression that the NHS is somehow giving up on those targets. The lead from the top is incredibly important. There has always been controversy about targets, but as Health Minister I visited many, many A&E departments. There is absolutely no doubt in my mind that the A&E target led to improved care for patients and that it reduced waiting times dramatically. The evidence is clear: it shows that that is what happened. One striking thing about those visits was seeing how consultants, nurses, ambulance teams and all members of the healthcare team worked together. For example, they would work out protocols so that emergency nurse practitioners could take over some of the work previously done by consultants in order to ease the burden and share the work among the team. Triaging—seeing who needed urgent treatment by a consultant and who could be seen by a nurse practitioner—became the norm.
I would ask staff, “Is the target getting in the way, or is it helping?”, and invariably the answer would come back, “It helps us to work together more effectively.” I vividly remember a nurse practitioner saying, “Please don’t abandon the target, because it is making the consultants sit down with us and look at the whole team.” For patients, the difference was crucial, as it was for practitioners’ working lives, because they were not having to see patients who had been sitting around for hours and were feeling thoroughly depressed and demoralised. That made a difference to the healthcare team as well, because it improved their working life as well as patient care.

Andrew Murrison: Does the right hon. Lady agree that it is not so much meeting the target that is important as getting patients seen expeditiously and well? There is not an A&E department in this country that does not want to improve its position in the league table, if you like, of response times. The difference that now applies, and which perhaps did not apply quite so much when she was a Minister, is that the level of informatics and comparison is much improved. I suggest to her, ever so gently, that while the four-hour target was important when she was a Minister, its importance has degraded over time, because everybody is trying to see patients more quickly.

Rosie Winterton: I do not agree with the hon. Gentleman. The four-hour target led to much better diagnoses and much improved provision of the type of treatment that people needed, as well as better interaction with communities. And I want to come on to that point because the Secretary of State has been trying—perhaps the hon. Gentleman is guilty of this as well—to separate the target for A&E departments from what happens outside, whereas I see the importance of putting the two together. Providing alternative treatment, which is perhaps part of what the hon. Gentleman was getting at, means having proper support in the community. It was bringing those two things together that made it possible to achieve the target, so it was a driver.

Maria Caulfield: Will the right hon. Lady give way?

Rosie Winterton: I give way to the hon. Lady, who I know has some experience of this.

Maria Caulfield: In my experience of trying to meet the four-hour target, it is often—or was in the past—prioritised over everything else, including patient care and clinical need. It was sometimes abused, with huge pressure put on staff to meet the target, and as a result patient care suffered. I saw that myself.

Rosie Winterton: It is always important to look at the feedback from clinicians, and I did that as a Health Minister. It started during my time as a Minister, and I remember that we had constantly to consider whether there was a clinical reason for reducing the 95% target. It became clear that some patients needed longer to be assessed owing to their particular condition. In such cases, I could see why the target might need to be reduced, but that was based on clinical need. By contrast, the impression given last week was, “My goodness! We’re going to have to cope with some winter pressures. Let’s reduce the target in order to meet it,” rather than there being an assessment of clinical need. That sent completely the wrong message to the NHS. I think it was the wrong thing to do.
I want briefly to set out some areas in which we can bring the community input together with what is happening in emergency departments in order to reduce some of the pressures. The first point was that made by my hon. Friend the Member for Leicester South (Jonathan Ashworth), who spoke from the Front Bench. Good social care is vital to ensuring that people do not end up in A&E. I have previously raised problems with the Government’s current proposition to, in a sense, move responsibility for raising money to local councils. That is particularly unfair in areas such as mine, which simply cannot raise the same amount of money through a council precept as better-off areas can. It simply does not work. We need it probably more than any other area, but we will be less able to raise the money.
On shortages, I have been talking to senior NHS staff in Doncaster, and there are real problems with emergency care staffing. They tell me that although more doctors are being trained—I accept that—it will take years for them to come through. The single most effective step we can take to ease pressure on A&E departments is immediately to increase funding for social care, because it would keep people out of A&E departments, and it could be done straightaway. The personnel are out there; the Government just need to increase the funding, as my hon. Friend said from the Front Bench.
We also have to look seriously at the problem of GP shortages. As others have said, if patients are waiting three weeks to get an appointment with a GP, they are bound to end up in A&E. This needs to be addressed very quickly, with proper forward looks at exactly where the gaps are in GP services. I have said before that PCTs—now clinical commissioning groups—or NHS England should be able to take over practices and employ salaried GPs. That would make a huge difference. Furthermore, on community pharmacies, if people are confident that going to a pharmacy will save them a visit to A&E, again that will relieve pressure on the system. I hope, therefore, that the Minister will assure us that he is looking seriously at the community pharmacy forward view, which sets out how pharmacies can be integrated into the NHS and social care.
Briefly on mental health, the Prime Minister answered a question today about mental health and the crises that people can get into which mean that they end up in  A&E—she talked, in particular, about young people. I urge the Minister to consider the role that educational psychologists can play in children’s mental health and in keeping them out of A&E.
It was my experience as a Health Minister that we needed people on the ground locally to help organisations across the spectrum—local government through to social care, pharmacies, GPs and ambulances—to work with A&E departments, yet the £2 billion reorganisation that removed PCTs and strategic health authorities has made it much more difficult to drive through the necessary changes. I hope, therefore, that the Minister will look very seriously at what has happened, because local knowledge can be vital.
On the basis of the Secretary of State’s contributions, it seemed that he was trying to use every excuse not to face up to the reality of what is happening. I think that sends a terrible message to NHS staff. I hope that, as a result of today’s debate, the concerns raised will be taken on board by Ministers and the Secretary of State and that they will come back to us with a proper plan that recognises the problems and offers real solutions.

Several hon. Members: rose—

Eleanor Laing: Order. The House was right to assume that 10 minutes per person is unsustainable. After the next speaker, I shall reduce the time limit to seven minutes. The House will be glad to know, however, that the time limit remains 10 minutes for Sir Simon Burns.

Simon Burns: Thank you very much, Madam Deputy Speaker.
I certainly welcome today’s debate and the opportunity to discuss an issue that is extremely important to all hon. Members in all parts of the House. During recent weeks, there has been a significant problem because of the increasing number of people needing services at A&E and from local health services. I would like to pay tribute to the magnificent work, often in very difficult circumstances, that doctors, nurses, consultants, ancillary staff and people in general practice carry out on a day-to-day basis—not simply during a winter crisis period, but throughout the year—looking after people to the best of their abilities.
My own hospital, Broomfield hospital in Chelmsford, is doing a fantastic job, in difficult circumstances, to provide the best possible care in good times and in more difficult times. As a constituency MP, I am certainly aware that there have been some problems for some of my constituents over the last week or so, because of the demand and the pressure.
We have to look at what we can do to move forward in a positive—not a partisan, politicised—way to make sure that our constituents get the best treatments possible. There is no point in just shouting. As the Chair of the Health Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said, it is no good engaging in yah-boo politics. We have to be mature and come up with sensible suggestions.
Funding is, of course, a key issue. I have to say that I am extremely proud of this Government’s record and commitment to funding the NHS over the last seven  years and their commitments for the next three to four years. We made sure when we came into office, at a time of austerity when Government Departments’ budgets were cut, that the Health Department’s budget was one of the few to be protected, so that we got a real-terms increase in funding every year we were in power—albeit, I accept, a modest real-terms increase. It nevertheless showed our commitment and our intent to invest in improving the national health service.
I am also proud of the fact that I and all my hon. and right hon. Friends fought the last general election on a commitment that over the five-year period of this Parliament, we were going to increase NHS funding substantially—to what has turned out to be to the tune of £10 billion. That is more, I say in a very gentle way, than was on offer to the country from certain other parties. I am pleased, too, that my right hon. Friend the Secretary of State and the Minister of State have been planning for any potential strains of demand during this winter period with the provision of £400 million to local health economies, and other measures such as the vaccination programme, a preventive health measure that has got a record number of 13 million people vaccinated to try to offset some of the potential health problems that can flow during a winter period. That is using foresight and planning to try to minimise problems, while at the same time providing funding to back up their actions. That is what a responsible Department of Health should do and has done.
Now, people can demand as much money as they like for the health service, but my argument is this. Yes, the health service does need extra money—year in, year out—but it should not just be thrown at an issue. A far bigger part of the equation is building on the performance, standards and quality of care that the health service will provide to our constituents.

Tania Mathias: Will my right hon. Friend give way?

Simon Burns: I will, very briefly.

Tania Mathias: I entirely agree with what my right hon. Friend is saying about the increased resources, but does he not agree with me that we now need more resources for integrated health and social care, and that this is the time to stop using the NHS as a political football and engage in a cross-party review?

Simon Burns: I certainly agree that, under the leadership of the Department of Health, we should work with anyone and everyone to come up with a solution.
I was the social care Minister in the late 1990s, before we left office. Integrating health and social care was then at a very early, formative stage, and the ambitions were immense and tremendous. I am afraid that the reality has not matched the ambitious nature of what was being said in the 1990s, which is why I was particularly interested by the comments of my hon. Friend the Member for Totnes. Yes, we must think about that, but what we must also think about—let me push the funding element to one side for the moment—is building on the work of my right hon. Friend the Secretary of State for Health, particularly his investment in patient safety, the raising of standards, dignity for patients in our hospitals and throughout the health system, and the cutting out of waste and inefficiencies.
In 2010, when I was at the Department of Health for the second time, we had the “Nicholson challenge”, which was to save £20 billion over three or four years by cutting out waste and sharing best practice to improve the quality of care. I know from a debate that we had just before Christmas that the NHS achieved £19.4 billion of those savings. The beauty of that was not just that it created greater effectiveness and efficiency in the delivery of healthcare and the sharing of best practice, but that the Treasury did not receive £19.4 billion with which it could do as it wished. The £19.4 billion was reinvested in patient care.

Philippa Whitford: Was not a significant proportion of that saving due to wage freezes for NHS medical and nursing staff? That is not something that can easily be repeated.

Simon Burns: The hon. Lady is absolutely right. There was a wage freeze for those who were earning more than £20,000 a year, but that was in keeping with the policy throughout the public sector, which included Ministers and other Members of Parliament.
The important point is that it was possible to achieve that saving by a variety of means. One of them was a pay freeze, but others were improving the delivery of service, cutting out inefficiencies and ineffective ways of operating, and getting rid of nearly 20,000 surplus managers so that the NHS could concentrate on enabling clinicians, nurses, ancillary workers and everyone else to work on patient care. That is the right way forward, and we cannot give up on it. We must continue to think about where we can make savings.

Andrew Murrison: Will my right hon. Friend give way?

Simon Burns: I am afraid not, because I am about to finish.
Much has been said about the STP programme. We have an STP in Mid and South Essex, and I strongly support it, because it is completely focused on improving and enhancing the quality of accident and emergency care. What annoys me is that people wish to politicise it for grubby political reasons. [Interruption.] Funnily enough, I am not talking about Opposition Members.
Our STP involves three hospitals with three A&E departments. Not one of those departments is to be closed under the proposals, yet as soon as they were published, and on the assumption—correct, I suspect—that most people had not read them, word went out that my local A&E department was to be closed down by the Department of Health because of this nasty Government’s proposals to save money. The exact opposite was the case. If one read the document, one could see that all three A&Es are remaining open. What will happen is building on what happens now. If someone has a heart attack, they are immediately taken to Basildon hospital, because that is the specialist for cardiothoracic treatment. If someone needs treatment for burns or plastic surgery, they come to Broomfield hospital in Chelmsford, because it has one of the finest units in the whole of Europe. If someone has a head injury, they will go down to Romford in the east of London, because that is the specialist area for people with head injuries. If I had any of those conditions, I would want—and I would want for my constituents—the best possible treatment from the best  experts available. That is what is happening and that is going to be built on, enhanced and improved. That is an improvement. That is not a cut; that is not taking away services from local communities. Those people who have an agenda and want to play politics will tell people anything in the hope that they believe it, or to frighten them by trying to discredit the work of the NHS.
I am pleased we have had the opportunity to discuss this matter. It is very tricky, and there is no simple answer—what is happening is not unique; we frequently have winter crises, particularly because of the ageing population and the increasing demands on health services in recent years—but we must not lose sight of the fact that we have an NHS and a Government who are determined to improve further and enhance the quality of care, and the safety and standards of care for all our constituents, aided and abetted by a first-class workforce who are often working under very difficult circumstances.

Louise Ellman: It is important to talk more widely about the NHS—about its importance and its funding and perhaps about its organisation, too—but the purpose of today’s debate is to highlight the current crisis in many parts of our national health service and to ask the Government to do something about it.
Our national health service is undoubtedly highly valued, has dedicated staff and provides excellent services. In many parts of the country it is under pressure, however, and today’s debate calls for specific actions to address that crisis. It calls for more funding for social care now, and for an improved settlement for both the NHS and social care in the next Budget. So in our general discussion about how things might be reorganised and changed in the future it is important not to lose focus on the current problems, and those are the reasons for today’s debate.
There has been a lot of discussion about what is happening in hospitals—that will inevitably be the case, as in many areas there is a crisis in A&E and great pressure on hospital services—but reference has also been made to services provided by our NHS outside hospitals, in the community. It is important that we focus on those as well, not just because they are important in their own right, but because if they are working effectively they can prevent hospital admissions from occurring and improve people’s health. Those services include community health services, which involve GP practices, which is the bedrock of our NHS, and the nurses, physios and pharmacists. They also include social care, where the NHS has some responsibility, although local authorities, which are under ever-increasing pressure, are primarily responsible.
I am extremely concerned about the cuts that the Government have imposed on community pharmacists. Pharmacists are essential to our NHS. They are part of the NHS, but in the main are privately run. They offer advice as well as specific services, and where pharmacists can give proper advice and services they can often prevent people from having to go to their GP, let alone to hospital. It is a matter of great concern that the Government’s plan for cuts to community pharmacies will put pharmacies in areas such as mine in Liverpool at risk. I also deplore the reduction in independent pharmacies, which provide an excellent service. I ask the  Government to think again about their cuts to community pharmacies, which form a vital part of our health service. Once they are closed, it will be far too late. The Government should act now. They should not go ahead with those cuts, which will have a dramatic effect in Liverpool and elsewhere in the country.
I also ask hon. Members to think a little more about what is happening in social care. In Liverpool, we are facing a major crisis in social care, as local authority funding has been cut severely and is to be cut again. Liverpool City Council’s budget has already been cut by 58%, and £90 million of further savings have been demanded over the next three years—half of that to be achieved in the next year. One result of that has been a severe reduction in social care provision: 40,000 social care packages have been reduced to 9,000, and there are many more cuts in the pipeline.
Providing social care is essential not just to enable people to leave hospital when they are healthy enough to do so—although that is important—but to enable them to live a constructive life. Many people are now fearful of possible cuts to their social care packages. They believe that they will be unable to lead a reasonable life in their own home if their essential services are cut. I ask the Government to think again about what they are doing. They tell us that the better care fund is an answer, but that is simply not the case. In Liverpool, £39 million has been proposed for the social care fund for the coming years, but that will simply scratch the surface of the problem. In poor areas such as Liverpool where it is difficult to raise money, a 1% increase in the council tax fund would raise only £1.4 million. Neither of those measures, either singly or put together, will address the looming and very real crisis in social care. I urge the Government to look again at this, rather than offering platitudes about other funding being available. That funding is not there, and there are no plans for it to be there. A new approach needs to be taken to this urgently; something needs to be done.
The subject of mental health has been raised by a number of Members. I should like to mention two instances from my constituency. The first involves someone who can live a reasonable life at home with some assistance, but that assistance has now been withdrawn. Among other things, it involved helping the person to open letters in order to deal with normal queries, but that has now gone and she is facing great problems.
The second example involves Mr B, who faces very serious mental health conditions. Indeed, he has an incapacitating condition, which means that he cannot work. He was promised specialist help at the Tuke Centre in York, but that offer was withdrawn because it was made in error. That is unforgivable. I have followed this through, and Mr B was promised local treatment, although it was unclear whether that treatment would be appropriate. However, that treatment is not now being offered in the way that was previously suggested. I have followed that up, but 14 months on from the time when Mr B was first offered help for his incapacitating and extremely serious mental health condition, nothing has happened. That is simply not good enough, and I shall be pursuing the matter further.
Those are just two illustrations of how the cruel cuts in mental health services are affecting individuals. I agree that we should perhaps look more generally at  funding for our national health service, but the crisis in local services is happening today. The Government are responsible now, and they must act.

Mark Harper: I am very pleased to follow the hon. Member for Liverpool, Riverside (Mrs Ellman). I am sorry that the hon. Member for Central Ayrshire (Dr Whitford) is no longer in her place. I particularly enjoyed her remarks, in which she set out a number of constructive policy suggestions, drawing on experience in Scotland, and suggested that we could reflect on them and improve the situation here.
It was disappointing to hear not a single policy suggestion in the shadow Secretary of State’s 33-minute contribution. He might reflect on that because the debate will not move forward otherwise.
The hon. Member for Central Ayrshire drew upon her clinical experience, but I also enjoyed the contribution of the right hon. Member for Doncaster Central (Dame Rosie Winterton) who, after a period of enforced silence as Opposition Chief Whip, drew upon her ministerial experience, demonstrating the value of ex-Ministers contributing from the Back Benches and bringing something to the debate.
I have reflected on the Labour motion before us today, which specifically talks about the four-hour target and funding issues, which I will touch on in my inevitably brief speech. As I said in an earlier intervention, I was in the House on Monday when the Secretary of State was clear in what he said and I do not understand why Labour Members fail to see that. He did not in any way water down the target. The right hon. Member for Exeter (Mr Bradshaw) challenged him and the Secretary of State specifically “recommitted the Government” to the target. He was actually generous in paying tribute to the Labour Government for having introduced it, saying that it was
“one of the best things about the NHS”,—[Official Report, 9 January 2017; Vol. 619, c. 46.]
and in no way resiled from it.
Indeed, I think the shadow Secretary of State said in his remarks that the Secretary of State had somehow talked about ensuring that the target applied only to those with urgent health problems and that he had somehow said that secretly outside the House. However, I have looked carefully at the Secretary of State’s oral statement, given in the House just two days ago, and he was explicit about ensuring that the four-hour standard related to urgent health problems. He specifically referenced Professor Keith Willett, NHS England’s medical director for acute care, and said that
“no country in the world has a”—
four-hour—
“standard for all health problems”.—[Official Report, 9 January 2017; Vol. 619, c. 38.]
The target is for urgent health problems, and if we are to protect vulnerable patients, that is what we need to ensure—it is incredibly valuable.
The motion also relates to social care funding, so I want to talk about the charge that the Opposition keep making about local authority decisions. It is entirely true that the coalition Government had to make savings from local government budgets in the previous Parliament owing to the previous Labour Government’s lack of  preparation following the dramatic financial crisis. We inherited a budget deficit of 11% and had to make such savings, but local councils had choices in the decisions they made about where the cuts fell. Gloucestershire County Council prioritised spending on adult social care, stating that it was the single most important service that it delivered. The budget related not only to older people; a third of it went on provision for adults with disabilities, including learning disabilities. The council protected that budget in cash terms, which is one reason why we are one of the best performers in the region and have low delayed patient discharge from the acute sector. While I do not pretend that there are no problems—of course there are challenges—the hard-working health and social care staff do an excellent job.

Toby Perkins: I am grateful to the right hon. Gentleman for giving way, but his comments about local government are ludicrous. The cuts that local government faced were far greater than those to any Government Department. The Government cannot introduce that level of cuts and then say to local government, “You have to decide what you cut.” Of course that was going to lead to social care cuts.

Mark Harper: The point that I was making is that my local authority also faced significant cuts and had to make choices. It chose to prioritise adult social care as the single most important service that it delivered, and that meant that it had to make difficult cuts in other areas. However, the choice to put adult social care at the top of the list of priorities was the right choice six years ago and remains the right choice today. If councils chose to put adult social care at the bottom of their list, that was not the right decision.
There is no acute A&E department in my constituency, but it is served by A&E departments in Gloucester and Cheltenham. I visited the new chief executive at Gloucestershire Hospitals NHS Foundation Trust and met some of the staff in the A&E department—the hospital has had its challenges—and she is working hard with her management team on turning around the performance of A&E, which has not been up to scratch. I talked to her about the processes they are putting in place, and I am confident that, with the hospital’s hard-working staff and improved leadership, they will be able to hit the targets that the Government have asked them to meet.

Alex Chalk: I joined Gloucestershire police on a night shift last Saturday, and I went to Gloucestershire Royal hospital A&E, too. I saw professional and compassionate staff offering care in no doubt pressured circumstances. Does my right hon. Friend agree that the current STP process in Gloucestershire must be the occasion to enhance capacity elsewhere in the county and that that must include bolstering and enhancing A&E provision at Cheltenham general hospital?

Mark Harper: The whole point of the STP process is to ensure that we have capacity across the health sector. One important thing that the Secretary of State talked about is the other changes to the health and social care system—indeed, that is mentioned in the Prime Minister’s  amendment, which is why I will support it. In that I agree completely with the Chair of the Select Committee. We have to look at the two things together.
Unlike what the hon. Member for Central Ayrshire (Dr Whitford) said, in Gloucestershire we are lucky to have a single CCG and a single county council, which work well together with lots of joint working, and they increasingly want to bring health and social care together. That is exactly what the Chair of the Select Committee said, it is the right thing to do and it is what the hon. Member for Central Ayrshire said is being done in Scotland to help deliver a better service.
My hon. Friend the Member for Cheltenham (Alex Chalk) is right that, the more we can improve capacity in the system to ensure that people can access primary care where they need it and can access social care where they need it, we will take pressure off the accident and emergency system. Indeed, when I visited the A&E department, it had a good triage system in place, with general practitioners based in the department to ensure that people with conditions that can be treated by general practice are signposted and treated in an appropriate setting, rather than damaging the service’s ability properly to deliver acute care to those who really need it. We need to consider such steps, going forward.

Andrew Murrison: Would those people fall within the four-hour target? That lies at the heart of the debate. Should the four-hour target cover both urgent and more elective problems that people present to casualty departments?

Mark Harper: I do not know the detail of how the statistics are measured, but the important thing is to ensure that people who walk through the front door of an A&E department but who do not need urgent care receive care in the appropriate setting and are properly signposted, whether that is to community pharmacies, general practice or the information services that the NHS provides online or on the telephone. It is about making sure that people go to the right setting. The Government acknowledge that that is not perfect at the moment, and they are doing a lot of work to improve it in the future.
Finally, the Government’s moves to devolve spending power and decision making to local areas, particularly given what will happen in Greater Manchester, to bring health and social care together is the way forward, and I have certainly encouraged my local authority, as it leads the formulation of our devolution proposals, to make an ambitious ask of Government on health. I hope the Government will look at that very seriously in the months ahead.

Catherine West: I do not know the collective noun for Government Chief Whips and Opposition Chief Whips, but I believe it is a crop of Whips. Anyway, it is an honour to follow two esteemed former Chief Whips.
I begin on a slightly less happy note by quoting from an educational psychologist who wrote to me this week:
“I and my colleagues are frequently overwhelmed, frustrated and in disbelief about the amount of work we need to manage, the difficulties in working across services because of cuts and   changes to policy. Everyone is perpetually exhausted and burnt out. When we’re not at work because of training, illness or leave we feel simultaneously guilty and relieved.”
Her email went on to describe how she is the only clinical psychologist on duty in the whole of a very busy inner-London constituency.
I wish to comment briefly on the juncture between primary and secondary care, and on acute care. In the past 18 months, many of us have had the experience of fighting for a general practitioner’s service. The Westbury clinic, which lies just between my constituency and that of my right hon. Friend the Member for Tottenham (Mr Lammy), has been quite a battleground in the past 12 months. He and I have had to really fight for basic GP services for our constituents. I believe this situation is replicated across the country, and it is obviously what is leading to the build-up of individuals; as the Secretary of State has said, we have so many people turning up to A&E who probably could be seen by a GP but simply cannot get an appointment.

Rob Flello: One problem we face in Stoke-on-Trent is that we are about half a dozen GPs away from the whole GP system collapsing, because as GPs are retiring or leaving for other reasons, their patients are then going to the ever-smaller number of GPs that there are. Two GPs are due to retire shortly, but if we lose half a dozen the whole GP system in Stoke-on-Trent is liable to collapse completely. What will that do to A&E?

Catherine West: That leads to an individual patient waiting 35 hours on a trolley to be seen, as happened this weekend. I know that a number of Members have made this point, but it bears repeating: it is disgraceful that staff are blamed when this is going wrong, given that the responsibility clearly lies with politicians—with the Government. I was upset to see that today’s front page of The Times blames the senior civil servant at the heart of the NHS, as this is really down to poor Government planning.

Steve Pound: On the subject of poor planning, I am sure that my hon. Friend will, like the rest of the House, have heard James O’Brien speaking on LBC yesterday describing his experience of having conjunctivitis over the Christmas holiday and having to go to a community pharmacist because he could not get a doctor’s appointment and did not want to go to A&E. Is this not the maddest time ever to be considering closing thousands of community pharmacies? Is this not the time when we should be supporting them, not closing them?

Catherine West: I do not know whether a Brexit-fever madness took over, but there was a moment when cutting community pharmacies seemed like the right thing to do. Clearly, it was the wrong thing to do at such a crucial time, particularly given the impact of the illnesses to which we all fall prey during the winter months.
In my earlier intervention, I asked the Secretary of State about the flu epidemic. He assured me on the number of vaccinations, and I am pleased that more people have been vaccinated against seasonal flu. However, let me return to the point I was making. I understand that there has been quite an increase in the number of  young people getting the flu, so we are not talking about people in the herd group who would have been advised to be inoculated against it. When people, tragically, get the flu they suffer, and doctors do not have time to isolate those individual cases. That creates a real risk, given how busy staff are, that that flu could become an epidemic. Having given us assurances today, I hope the Secretary of State will take that point up further with chief executives of acute trusts.
I want to give colleagues an idea of what is happening on social care. In 2010, I was a council leader and we had a social care budget for children—this is nothing to do with schools, just children—of £102 million. The same local authority now, in a busy London area, has for 2017-18 got a budget of £46 million. If someone is really telling me that the needs are half as much as they were in 2010 or that somehow families need less help and support, which is what children’s social care provides, I would be very surprised. A cut from £102 million to £46 million in 2017-18 is deeply worrying for the children who are in desperate need of social care.
Adult social care is equally worrying. The Secretary of State told us on Monday that we should not worry because £600 million is going into social care. I would not worry, except that I happen to know that, between 2010 and 2015, £4.8 billion was taken out. Anyone who has even key stage 2 maths will know that that does not add up. If £4.8 billion is taken out over a five-year Parliament, putting in £600 million 18 months later is not going to help.
I feel sorry for councils. If they increase tax, that is quite unpopular, but if they do not the Government blame them for not wanting to sort out the social care crisis. Even where the precept does bring the local authority quite a lot of money, the amounts raised do not help in the longer term because they just go towards a short-term fix—we are not actually fixing the problem that we need to be looking at: we need more homes in which older people can live comfortably, have fewer falls and accidents, be warmer so that they are not suffering from fuel poverty, and stay out of A&Es.
It is all about long-term planning, but we have built hardly any new homes, even for older folk. If we did so we could start a chain and enable their families to move into their old homes, thereby solving another problem. We have reached a crisis in which older folk end up in A&E and, on occasion, have to wait on a trolley for 35 hours, which I still cannot quite believe. I am sure that the newspapers are telling the truth, but 35 hours is an awfully long time to be on a trolley and not be seen.
Last year, my right hon. Friend the Member for Tottenham and I had a debate on mental health in this very Chamber, which was followed by a meeting of Members of Parliament from the local sub-region. We were very worried about people suffering from mental health problems, for whom there is currently a perfect storm. First, there have been benefits cuts. We are now in our seventh year of austerity, and there is no doubt that people with mental health problems have been right at the bottom of the pile. Secondly, we have seen cuts to supported housing and all the programmes that helped people suffering with mental health problems to keep their tenancies. That is all being cut, so people have no one to support them, which is part of the reason they fall ill. Thirdly, we have seen cuts to the  number of nurses. There are fewer mental health nurses in the system than there were two years ago and, of course, fewer beds.
A constituent came to see me at my surgery in November to say that he had fallen ill with a mental health problem. He was very surprised because he had never suffered in such a way before, and was amazed by the poor care he received, in part because no one was available to diagnose him properly. He spent more than 24 hours in a padded cell, with no explanation and no indication of what sort of service he could expect. There were so few beds that he was sent about 20 miles away to be cared for at another hospital, leading to a great deal of stress and worry for his family.
The whole health system is in crisis and needs our urgent attention. Despite all the demands, political and otherwise, that the Brexit process is going to create, I hope we will not forget not only the most vulnerable—those with mental health problems or in social care and so on—but our basic, universal NHS for all.

Andrea Jenkyns: I begin by objecting to the exaggerated language used over the weekend by Mike Adamson, the chief executive of the British Red Cross. What he said does a huge disservice to our hard-working healthcare professionals in the NHS. Such language was ill-thought-out, sloppy and irresponsible. The Red Cross does some fantastic work, as I am sure both sides of the House agree, but as a registered charity it is legally obliged to be apolitical. If Mike Adamson cannot remain neutral, I suggest that he examines his position carefully.
As a member of the Health Committee and chair and co-founder of the patient safety all-party group, healthcare is extremely important to me, and I am proud to be a Conservative Member of Parliament under this Government. It is thanks to this Government and this Health Secretary that NHS funding is at record levels.
The Government are committed to delivering a seven-day NHS and to expanding access to GP surgeries and hospital-based consultants at evenings and weekends. This winter, the NHS has made more extensive preparations than ever before. As the Secretary of State mentioned earlier, in the run-up to the winter period, there were over 1,600 more doctors and 3,000 more nurses than just a year ago. That is a record of which to be proud, and it would not have been achieved had we had the Opposition party running our national health service.
As chair of the patient safety APPG, I am pleased to say that the Government have introduced a new Ofsted-style inspection regime for the Care Quality Commission to improve patient safety. Hospital infections have been halved since 2010, with the level of MRSA down by virtually 50% and clostridium difficile by more than 50%. It is this Health Secretary who has taken the lead on this issue, and put patients at the heart of the NHS.
Record numbers of people are being treated in our NHS and there are pressures on the service, but it is not this Conservative Government who are a threat to the NHS. If we look at the appalling situation of the NHS in Labour-controlled Wales, we will see that funding is being cut. As the latest statistics show, the NHS in Wales is failing to meet the four-hour A&E targets by a  wide margin. It is clear to see who is rarely the defender of our national health service and who would cut investment.
In conclusion, it is this Government who are increasing spending on our NHS, who are focusing on improving patient safety and who are dedicated to providing the best possible service.

Naseem Shah: I am grateful for this opportunity to raise some of the serious concerns that have been caused by this Government’s refusal to fully fund our NHS. The Government are running out of places to cut corners to save money on the NHS. They are showing a lack of respect and compassion as they fail to provide the healthcare that people need and deserve. Those who need care at home are having to make do with 15-minute flying visits.
We have seen the pressure in A&E departments building over the past six years and yet every year we reach a “winter crisis” that is somehow a surprise to the Government. We have seen an increase in A&E waiting times, with more than 1.8 million people waiting more than four hours in 2015-16—an increase of over 400% since 2010.
Bed-blocking is increasing as our underfunded social care services struggle to deal with demand. We have seen an increase in the number of patients waiting on trolleys to be treated or admitted, and an increase in the number of hospitals running out of beds. We are also about to see a 12% cut to community pharmacies, which will lead to the closure or reduction in services of our local pharmacies. The time it takes to get a GP appointment is also increasing.
This is not the most complex of problems. If we want a proper functioning full person-centred care system that works with compassion and treats those in need professionally and efficiently, this Government must fund it.

Alex Chalk: In 2015, the head of the NHS, Sir Simon Stevens, said that the NHS needed £8 billion. It was this party that committed to fund it; the Labour party did not. If the hon. Lady is so keen on funding the NHS, why did the Labour party not pledge to do so back in 2015?

Naseem Shah: I thank the hon. Gentleman for his intervention.
Let me turn now to pharmacies. This Government fail to grasp the fact that cuts to one service will have a direct impact on another. Let me be clear: only two months ago, I stood on the Floor of this House to condemn the proposed 12% cut to community pharmacies, which could mean the closure of 25% of the 42 pharmacies in my Bradford West constituency. That highlights the short-sighted approach taken by this Government. They are attacking all forms of primary healthcare and front-line services on which people rely.
If the figures are correct, nearly 30% of people who attended A&E services in Bradford royal infirmary over the past month could have been treated elsewhere for minor ailments. Many of them could go to their local pharmacy, through our local ailments scheme, or see their GP. What is the Government’s long-term approach  to these systemic issues if they continue to water down primary care services? All we will see is an increase in the number of visitors unnecessarily attending A&E and an increase in the problems faced by those needing access to services.
The impact of the reduction in GP services is the same. Only a few months ago, I campaigned with the local community to save Manningham health practice. That was temporarily put on hold, although we still have fears. Thankfully, we managed to prevent that centre from being closed down in the short term. However, I know that others in my constituency are at risk. Many other MPs have GP surgeries in their constituencies that face uncertain futures due to the funding restraints. This paints a picture not only of the underfunding of primary care services, but of a strategy that simply does not work together. Even a simple understanding of healthcare provision would allow us to see that if we decrease NHS services in one sector, there is an impact on the rest of it and an increased pressure on other service providers. But this Government continue to underfund and cut funding to all aspects of frontline services, and they expect the quality of care to remain the same. Where is the long-term planning that will ensure that people get access to the care that they deserve and are entitled to?
The Government’s strategy is the same when it comes to local government social care funding. The cuts to local social care funding have been dramatic. As many other hon. Members have highlighted, nearly £4.6 billion has been taken out of the social care sector since 2010, mainly through local government funding cuts. My district of Bradford has just had to announce that it will need to find another £8 million in savings from its social care budget. The authority is trying to be innovative and trying to find ways to ensure that there is no effect on frontline care by putting its resources into prevention. For me, the Government still fail to recognise the impact of deprivation on care needs. In one of the four most deprived constituencies, health issues go hand in hand with deprivation. The cuts to local government funding make that even more evident. It is not the work of our exceptional healthcare staff that has caused this crisis. It is the reduction in funding and the short-term strategy of this Government that are responsible. It is time for them to wake up and provide the healthcare provision people deserve.

Andrew Selous: Many of my constituents are extremely fortunate to be served by Luton and Dunstable hospital—the hospital that was name-checked twice by the Secretary of State in his statement on Monday. One thing it does extremely well is its excellent streaming process in A&E, with good alternatives when A&E provision is not appropriate. That has helped the hospital to provide very high standards. I am also fortunate that my constituents’ social care is provided by Central Bedfordshire Council, which has been extremely innovative in building extra care court provision for older people. I visited those provisions, which are hugely popular and in central locations. They are much cheaper than residential care and provide a much better living environment for older people. That is exactly the sort of thing that we need a lot more of across the country. Those are two examples of really  good individual practice within the NHS and social care. We need to be much better at spreading that good practice across the whole country.
It is worth putting on the record that since this time last year, we have more than 1,600 more doctors and 3,100 more hospital nurses. Since 2010, we have over 11,000 more doctors and 11,000 more nurses. The proportion of patients harmed by the NHS fell by more than a third between 2012 and 2015, and cases of infection are 50% lower than they were one year ago, which is a tremendous achievement. Health spending in England is actually 1% higher than the OECD average and the UK is spending more on long-term care as a percentage of GDP than Germany, Canada and the USA. The King’s Fund has said that STPs are the “best hope” for the future of the NHS in England, and Chris Hopson, the head of NHS Providers, has said that the system as a whole is doing “slightly better” than this time last year.
All of that is dependent on having a strong economy, and I would argue that the Conservative party has demonstrated its competence in running the economy. Of course, I am not complacent, and I recognise that there is, in a sense, an arms race between the extra provision I am proud the Government have put in and the increasing demands on the NHS.
One issue that continually disappoints me is that we do not have enough of a focus on quality in these debates—they are always about funding. However, I draw attention again to the “Getting it Right First Time” initiative brought in by the Government just before Christmas, which is projected to save £1.5 billion that could be redirected back towards front-line patient care across 18 specialties. That will result in fewer infections and fewer revision operations, and we are using the data to shine a spotlight on variability, which is absolutely key for our constituents.
On mental health and the very welcome statement by the Prime Minister on Monday, I was delighted to hear the emphasis on first aid for mental health—something that will take place in our schools. However, as important, if not more important, is the issue of keeping fit for mental health. What do all of us need to do to maintain good mental health? The Mental Health Foundation says we need to talk about our feelings, eat well, keep in touch with family and friends, take a break, accept who we are, keep active, drink sensibly, ask for help, do something we are good at and care for others. I do not think those 10 pointers from the Mental Health Foundation are as well known as they should be, so I am pleased to have put them on the record. It is crucial that all of us look after our mental health, and that will help to reduce the stigma in this area.
Another issue I am passionate about is doing something about obesity, because although we have a national health service, we do not do enough to keep our fellow citizens healthy. I would like to see more emphasis placed on the excellent work of Dr Susan Jebb, an academic at the University of Oxford. She published an article in The Lancet just before Christmas showing that where GPs offered obese patients a referral to 12 weekly one-hour sessions, there was a significant reduction in the patients’ obesity.

Steve Pound: I am sure the hon. Gentleman, like me, is a regular reader of the Daily Mail, and he will have noticed the proposal in yesterday’s paper that  people who are obese, heavy smokers or even, God forbid, both should be denied medical treatment until they lose weight or stop the filthy habit of smoking. Would he like to recommend to those on his Front Bench the adoption of that policy?

Andrew Selous: What I am focusing on is what we can do to keep ourselves healthy and to reduce the demands on the NHS by behaving responsibly, and that is what I want to put the emphasis on.
That is important because a quarter of adults are obese, as are 14% of children between the ages of two and 15, and 18% of children in lower income households. Those figures should shame us all, and that is why I intervened on the hon. Member for Central Ayrshire (Dr Whitford) and mentioned the daily mile, which was brought in by St Ninian’s Primary School in Stirling. We need to see more of that and, frankly, a strengthened obesity policy.
My daily newspaper at the moment is the China Daily—it happens to be delivered free to my office. I was intrigued to see that students at universities in China actually have to take a physical fitness test lasting 50 minutes at the beginning of each new semester or they will not be given a graduation certificate. I am not necessarily suggesting that we introduce that here, but we should look around the world to see what other countries are doing to promote the health of their populations—to keep them fit and healthy—and to reduce the pressure on health services.
At the other end of the age spectrum, we need to do a lot more to keep older people fit and healthy, as many of the issues with social care would be greatly lessened if older people were able to stay healthier into later life. I am proud to be associated with the Buzzards 50+ organisation in my constituency, which helps older people to take regular exercise at our local leisure centres. In Andorra, which I mentioned earlier, that is normal for the whole population. Older people in their 70s and 80s will regularly take part in water aerobics classes and go to the gym. When a BBC correspondent went there a few years ago, women in their 70s taking part in these exercises said, “There’s no point in spending your retirement shut up at home. What’s more important than keeping yourself fit? If you don’t keep your body moving, you won’t keep your mind in shape.” Frankly, we need a lot more of that type of activity in our own country in order to lessen the pressures on our social care system.

Mark Hendrick: We have heard from Conservative Members about the so-called annual winter crisis, as though the situation we are in at the moment has always existed. Well, there have been crises in the past, but nothing like on the scale that we have seen recently. We are hearing about corridors being used as wards. I saw this in my own local hospital when I had to take my young son there. We went through into the ward and saw queues of trolleys with patients on them before my little son was seen to.
Last December, I wrote to the Department with a question—it was answered by the Minister of State, the hon. Member for Ludlow (Mr Dunne), who is in his place—about whether the Government could give the  figures for the number of patients left queuing in corridors. I was told that there were no such figures. The Government and the Minister are well aware that this is going on in hospitals up and down the country. If the Government do not collect those figures centrally, but hospitals themselves collect them, the Government should ask for them; and if hospitals do not collect them, they are not carrying out their duty of care to our constituents, because it is important that people know how many patients are being held in corridors.
We hear stories about ambulances being redirected and bed occupancies being well over the 85% recommended level, and in many cases well over 95%. We have heard about the £4.6 billion of cuts in social care funding. Already, while it has not been made explicit, we are hearing talk of downgrading the four-hour A&E wait. In Preston, as I know myself, it is difficult to get GP appointments. If I ring and ask to see the doctor I want to see, I am often told that I will have to wait two to three hours—I mean weeks—to see that doctor. It probably will be two to three hours, at the very least, if I go to the hospital and it is a serious case. It is no wonder A&E is in crisis. A whole cohort of doctors in their mid-to-late 50s are looking forward to retirement. The number of doctors has increased, as we heard from the Health Secretary today, but that increase is nowhere near matching the number of doctors who are leaving the service or going to work elsewhere.
On the social care sector, in Lancashire we have seen tens of millions of pounds of Government cuts forced on Lancashire County Council. That is leaving the elderly vulnerable and more likely to have accidents at home, putting pressure on A&E as well. The mental health services—the Cinderella services—continue not to get the support they deserve. Since the closure of the acute mental health ward in Royal Preston hospital, the Avondale unit, I have seen mental health patients being decanted around Lancashire because they cannot get the care and support that they need in Preston.
Over a five-month period to August last year, we saw a 16% increase in attendance at A&E at Royal Preston hospital. Over the same period, average daily patient attendance increased from 217 per day to 255 per day. A small percentage of that increase was due to the closure of Chorley and South Ribble hospital’s A&E. I am sure that if the Deputy Speaker, my right hon. Friend the Member for Chorley (Mr Hoyle), were here, he would echo what I have said. However, it is not all due to the closure of Chorley’s A&E. Many patients who would have gone to Chorley are now attending the A&E in Wigan, or elsewhere. The Government should not be allowing wards to close when the demand is so high. The daily average for the number of ambulance arrivals has increased from 68 to 91, according to the North West Ambulance Service. In the meantime, a return to a 24-hour accident and emergency service at Chorley hospital has been ruled out. At best, there will be a 12-hour A&E service sometime later this month.
Preston has one of the 134 of 138 A&E departments up and down the country in which 95% of patients are not seen within four hours. I believe it is an absolute disgrace that only four A&Es in the country are meeting the four-hour standard. It is testimony to the cuts and austerity being forced on the NHS and local government social services departments up and down the country.  I call on the Government to increase spending on social care and to fund the NHS further in this year’s Budget as a matter of urgency.

Wendy Morton: It is a pleasure to follow the hon. Member for Preston (Mr Hendrick) in this debate. I am very conscious that I am following many Members on both sides of the Chamber who are far more learned about health matters and who bring with them very valuable experience from the frontline in the NHS.
Like all Members in the Chamber, I receive letters and visits from constituents who have concerns about the NHS and issues with their own health. As we all know, some of those issues can be very sad and emotive, and we all do our utmost to help them in what can be very difficult situations. However, let us not forget the many positive stories and experiences that we also hear about. Many of us will have had very positive experiences with the NHS in relation to how it has helped and continues to help us and our own families. It would be very wrong and unfair of us not to recognise those experiences.
I thank all NHS staff and those who work in the health and social care sectors for the work they do not just during the hard times, such as now, when there are winter pressures, but day in and day out throughout the year. In my family—my mother was a home carer for many years, and my sister is currently a practice nurse—I often hear about what it is like to work on the frontline. I also thank our local hospital in Walsall, the Manor hospital, which serves the constituents of Aldridge-Brownhills. Like many other hospitals, it faces many pressures. As we have heard today, A&Es saw the highest number of patients on the Tuesday after Christmas. I believe that all those involved in healthcare are working extremely hard to tackle this problem, and that includes the Secretary of State and his Ministers, with their work to do that and to move us towards a better and more sustainable future.
Hospitals across the country face huge pressures as we enter the winter period, as I have said. We increasingly have an ageing population, but the population is also increasing in numbers and many more treatment options are available than ever before. As we all know, many of those treatments come at a very high cost, but we would like to be able to meet that cost to help those patients. All these factors place challenges and pressures on the NHS, its staff and its resources. The impact of the ageing population has been raised with me by some of my local GPs, and we need to recognise and tackle this issue. I know that GPs in my surgeries would very much welcome the Minister if he were to drop by Aldridge-Brownhills on his way back to Shropshire one Friday for what would be a very useful and constructive roundtable discussion. That is an invitation to the Minister.
It is important to develop effective and integrated health and social care, but although money is an important factor, I do not believe this is just about money. In fact, the Secretary of State said in his speech today that we miss a trick if we say that it is. We forget that it is also about making progress on safety, standards and quality. I recall that a number of years ago, the headlines in the papers were always about really nasty  hospital bugs and infections such as MRSA and clostridium difficile, and we have come a long way in working to combat those.
I am proud that the Government are committed to the NHS, and that as we enter the winter period we have nearly 1,800 more doctors and nearly 3,000 more hospital nurses than we had a year ago. We have launched the largest ever flu vaccine programme and allocated £400 million to local health systems for winter preparedness, and we have bolstered support outside A&E with 12,000 additional GP sessions over the festive period. Of course, there is and always will be more to do, but I believe that we are rising to the challenge and will continue to do so. I am sure that the Secretary of State and his team will continue to rise to that challenge as well.

Owen Smith: I do not intend to take too long, because I am mindful of the fact that the motion refers largely to NHS England, but I am goaded to speak by the repeated references by the current Secretary of State, the previous Prime Minister and the current Prime Minister to the relative performance of the NHS in Wales. I want to take a few minutes to set the record straight and give a clearer illustration of the relative performance of the two NHS systems.
Before I do that, I want to reflect on the interesting, thoughtful speech that the Prime Minister gave earlier this week about her desire to create a “shared society”, as she put it, in Britain. I read the speech, as many Members did, and felt that it set out precisely what all Governments ought to be doing at all times. In one passage, the Prime Minister said:
“That is why I believe that…the central challenge of our times is to overcome division and bring our country together.”
She said that she wanted to create
“a society that respects the bonds that we share as a union of people and nations.”
I completely agree with her about that, but I find it impossible to reconcile that stated objective and rhetoric with how she and, in particular, her predecessor have sought to divide this country on the issue of the NHS. They have illegitimately demeaned the performance of the NHS in Wales, demoralised its staff and destroyed confidence and faith in it among Welsh citizens. With a few statistics, I hope to illustrate how misleading some of the representations in recent years have been.
The first statistic is that the previous Prime Minister referred to the NHS in Wales in a disparaging fashion 37 times, on every occasion as a political attempt to militate against criticism of the NHS in England. That broke the important bonds between different parts of the UK. I will state a few of the facts. The entire budget for Wales is about £15 billion per annum, and £7.1 billion of that is spent on the NHS. That is 48% of all spending by the Government in Wales. The difference between that and the situation in England is enormous. In England, the NHS budget is £120 billion, and the entire budget of the country is about £750 billion, so 16% of the budget is spent on the NHS in England and 48% in Wales. The Welsh Government’s headroom to expand spending on the NHS instead of other areas is therefore dramatically less than in England. That is the first illegitimate way in which the Government have manipulated statistics on the issue.
Secondly, over the past six years the Government have repeatedly referred to the lesser spending on the NHS in Wales than in England per head or in percentage terms. We have heard that three times today already. The truth is that in 2010 the Welsh Government, with the lower headroom that I have mentioned, chose to reduce spending on the NHS by 1% compared with the previous year. In England, there was flat cash spending. That 1% reduction was made to increase and prioritise spending on education in Wales. Since then, we have seen successive rounds of investment by the Welsh Government: £80 million was announced this week for a new treatment fund; last week, there was £40 million for capital spending. It is now broadly comparable in percentage terms. In fact, last year in Wales we spent £2,026 per head, while England spent £2,028. The difference is negligible. If we add health and social care together, we find that Wales spent 6% more per head than England. These are the realities of the comparative spending.
What has it given us in outputs? There are some things that the Welsh NHS does worse. In Wales, we wait longer for some diagnostic treatment. There is a need to spend more on more MRI scanners and CT scanners. Part of the issue, however, relates to an older and sicker post-industrial population, rural sparsity and a lesser ability to attract people to some of the more far-flung hospitals—all perfectly explicable and reasonable. In England, over the past nine months we have seen the biggest rise in waiting lists for nine years.
In other areas, Wales does well. On the crucial eight-minute ambulance response time, 77% of calls meet it in Wales, against only 67% in England. Most would agree that the 62-day cancer treatment target is vital, but in England it is consistently missed. In England, on average, 81% of people are treated within the target time; in Wales, the figure is currently 86%. There are other areas I could turn to. A&E is the crucial area we are looking at today. In Wales, 83% of patients are currently seen within the four-hour target. In England, the figure is 88%. There are 150 A& E departments in England and only six or seven in Wales, so this is another completely ludicrous and, in many respects, meaningless statistical comparison. Thirty seven of the 150 A&E departments in England are below the Welsh average. Several of the Welsh trusts are up at the 95% or 98% mark. This is a further illustration of how meaningless, misleading and frankly abusive it has been of the Tories to use the Welsh NHS as a stick to score political points.
In conclusion, the truth about the Welsh NHS is that it performs excellently in some areas and that it could be improved in others. As the OECD said, in a 10-year study of all the healthcare systems across the country, no one part of Britain performs demonstrably better or worse than any other. That is the truth about the differences between our NHS in this country. I say to the Minister that he, the Prime Minister and the Secretary of State need to remember that they are Ministers for the whole of the United Kingdom, not just England. Their duty is to increase the bonds of solidary, not destroy them.

Andrew Murrison: This has been an absolutely first-rate debate, with a number of extremely fine contributions. I was particularly  taken, as ever, by the remarks of my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Select Committee. She rightly pointed out that we are all living longer, which is a great thing, but that unfortunately our healthy lives are not expanding. This causes real problems for A&E, which has to deal with that. Although we talk about large numbers of people passing through A&E departments—they are dealing with more people all the time—the truth of the matter is that it is those with chronic long-term and complicated conditions who tend to assume the lion’s share of A&E resources and those of the rest of the secondary care system. As we get older, there will be more and more of such cases. We need to prepare for them.
We also need to militate against those cases. One thing that has not been discussed very much this afternoon is prevention and public health: our need to ensure that we deal with things that are avoidable. The Prime Minister, in her excellent speech on Monday on the shared society, rightly said:
“We live in a country where if you’re born poor, you will die on average 9 years earlier than others.”
That is absolutely appalling and we should all be ashamed. Half of that health inequality is due to tobacco consumption. Someone in a manual occupation is far more likely to be a smoker or to smoke more than a professional or managerial person. We have to be serious about controlling the scourge of tobacco. I encourage Ministers to produce the tobacco control plan, which is now overdue, as soon as possible, as we need to deal with this issue. I hope that the plan will contain some helpful remarks on the tobacco duty escalator and the licensing of retailers and involve serious conversations with supermarkets. The aim must be to reduce the availability of tobacco, reduce consumption and therefore reduce the burden of diseases that are affecting our NHS and having appalling consequences for citizens.
I very much support the Government’s amendment to the motion. I was not present when the hon. Member for Central Ayrshire (Dr Whitford), who speaks for the SNP, was speaking about community hospitals. I am sorry about that, because community hospitals are particularly important to me and I would have liked to respond to some of her remarks. I have community hospitals in my area. In particular, there is one serving my constituency at Shaftesbury that is threatened with bed closures under the STP. We need to be very careful about short-term funding cuts that might appear expedient, when we have not properly costed the service. Providing that the case mix is right—and traditionally case mixes have been pretty appalling in the NHS—community hospital beds can provide a cost-effective means of treating people, particularly the elderly, in a setting close to their homes rather than in large acute hospitals, which are the wrong places for elderly sick people. Community hospitals can deal quite effectively with some of the delayed discharge problems currently afflicting our system. As Members of Parliament, we are all sometimes faced with the political choice of whether to oppose, for our own expediency, the closure or reorganisation of services. I have faced that in my constituency. I was pleased to hear my right hon. Friend the Member for Chelmsford (Sir Simon Burns) say that sometimes we need to be brave when approaching such matters.
If we want to drive up standards and outcomes in our NHS, we will have to look increasingly at specialist centres, which will inevitably mean service reconfiguration and probably some closures. That will be disagreeable to many colleagues, but specialist centres certainly improve standards and outcomes for things such as cancer, strokes and heart attacks, and that implies regional and sub-regional services. I would not be one to oppose a closure, reorganisation or reconfiguration for its own sake. We have always to understand that resources are finite and that we need to get the best service and outcomes for the money available.
I say gently to the Minister that we need to look at funding. He will be aware of the campaign by the right hon. Member for North Norfolk (Norman Lamb), which I support, in relation to a commission or convention. It seems a non-partisan way of trying to approach the very difficult conundrum of how we will fund the NHS going forward. I commend it to the Minister. I was pleased to hear the Prime Minister say at lunchtime that she was prepared to meet colleagues concerned about the issue to see whether this proposal could be a productive and helpful way forward. We do not spend as much on the NHS as we need to. That is the bottom line. It is no good people saying we spend 1% above the OECD average. That is not good enough, given that the OECD includes countries with which most people in this country would not wish to be compared. As the Government of the day made clear several years ago now, we need to close the gap with the EU 15, particularly with countries such as Germany, France and the Netherlands, whose outcomes are much better than ours. It is no coincidence that they spend much more on healthcare.
Today, the chief executive of the NHS is being examined by the Public Accounts Committee. I hope he will be examined on the £22 billion efficiency measures that he felt might be achievable in the five year forward view. Two years in and it is clear that those savings will not be met—they never were going to be met. We need to determine how we are going to make up the delta—the difference—between the efficiency measures that the NHS can reasonably achieve and those projected two years ago.
I want to finish by congratulating the Minister and the Government on achieving what they have. We have heard how things have improved in recent years, particularly in relation to such things as activity and hospital infections, but there is much more to do. In particular, I hope he will look closely at the funding issue.

Toby Perkins: This is a vital issue, and I congratulate my hon. Friend the Member for Leicester South (Jonathan Ashworth) on bringing it before the House. The pressures on our national health service have a multitude of causes. Many of them are societal: whoever was in power would be dealing with an ageing population, limited financial resources and global competition for skills. However, many aspects of the crisis have a political origin, and the Government cannot continue to avert their eyes from that.
In my contribution today, I want to talk about my own experience of the pressures that our NHS staff, and particularly those in A&E, are facing, and ask Members to walk a mile in the shoes of those who are on the frontline, making life-and-death decisions every single  day. My exposure to these pressures is both professional and personal. Professionally, in common with many other MPs, I have recently spent time in the A&E department of my local hospital, the Chesterfield royal, shadowing staff on the watch.
I have said that my exposure to these issues was also a personal one. Last year, on Friday 15 July, my father died of an aneurysm. Four days earlier, he had been sent home from the A&E department at Coventry and Warwickshire hospital with what a vascular surgeon described at my father’s inquest as “classical aneurysm symptoms”. With a history of vascular problems and a previous near-fatal aneurysm, he presented at the hospital’s A&E department, suffering extreme pain in his right groin, radiating to side and back. He was described as being confused and uncommunicative. Yet, after five hours in A&E, he was sent home in a taxi. Four days later, he died in my arms.
Although individual mistakes by an experienced and, I believe, respected A&E registrar were clearly made in this case, what was particularly haunting was his response to questions during the inquest about why my father was sent home. He recounted the pressures in the A&E department that day, and said that it was non-stop and particularly busy on that Friday afternoon, so that from one case to another, he was constantly having to decide, as he did most days, which sick patients, all of whom needed to be in a hospital bed, to send home this time. He said:
“There simply aren’t enough beds for those who need to be in them, so every day we have to make these choices. I probably sent home 5 people that day who should have been in a hospital bed, but those are the choices we are left with, when there aren’t enough beds”.
He asked if my father minded going home and when he did not object, he stuck him in a cab.
These pressures and these life-or-death decisions are not unique to that registrar or that hospital. Dr Stephen Hitchin, an out-of-hours doctor and an A&E doctor at Chesterfield royal said:
“Chesterfield Royal Hospital have confirmed to the CCG today that they are experiencing SEVERE pressure (RED STATUS) in A&E, Emergency Management Unit, Clinical Decision Unit and critical care beds…This has come from a toxic combination of underinvestment, social care cuts, staff cuts, poor planning and GP surgery shortages. This is a failure of policy from this Government plain & simple. They are to blame & must take responsibility & action to correct this crisis”.
Another consultant said:
“The only thing keeping the wheels even vaguely on is a grim determination and professionalism. Any good will to the system was eroded months ago. The government have thought that Emergency Departments can just soak up exploitation and abuse ad infinitum but we can’t. We have exceeded ‘acceptable tolerances’ long ago.”
If that is the experience of people working within the system, how can we be surprised when it leads to personal catastrophes? How can we be surprised when doctors on whom we have spent tens of thousands of pounds to train, take the expensive training and move to other countries where they feel they are better appreciated? The experiences of those consultants and registrars were echoed by those I met when shadowing the A&E department at Chesterfield royal. Other issues emerged. Certainly there were people in the A&E department who were not urgent cases and should have been at their GP. When I asked one of them why he had  come to A&E, he said it was because he had been trying to get a doctor’s appointment for three days at his GP surgery and just could not get one.
The scale of the GP crisis is adding to our A&E crisis, not just because people present who should be seeing a GP, but because problems that could have been sorted out or identified if they were seen early enough escalate without access to primary care. The Government must take responsibility. The cuts in training budgets in 2010-11 and 2011-12 were catastrophic for the provision of the next generation of staff, and we are now reaping the full cost of that decision. Quite apart from the ethics of having to rely on overseas staff to keep our NHS sustainable and the impact that has on health services in developing countries, it is crazy that, at a time of a global shortage of trained medical staff, the Government deliberately cut off the flow of new home-grown recruits.
The story is similar in nursing. In 2010-11, 25,525 students enrolled on a nursing degree course, but owing to budget cuts, that number had been reduced by nearly 15% within two years of a Tory Government, and even now it is more than 10% down. The staff shortages have also led to a ballooning of agency costs: in the past two years, an additional £2 billion has been spent on agency staff. More and more money is being spent on extra staff and not, as it should be, on patient care.
We need to remind ourselves that things were different under a Labour Government. A Labour Government led to record NHS satisfaction levels, achievement of the 98% waiting target, a sustainable GP and A&E system, and, in the words of the King’s Fund, the most efficient health service in the world. The Labour Government led to much higher patient expectations, but under the present Government that progress is being eroded. By 2008, after 11 years of Labour investment, the UK’s health spending had finally caught up with that of leading EU nations, but OECD figures show that, once again, our spending is now “significantly below” theirs.
I am ashamed to say that I am grateful that my father experienced his first life-threatening aneurysm on holiday in Germany. The quality of the emergency care that he received in Munich saved his life and gave us, his family, three more years with him. I regret that the same could not be said of our NHS last year.
We have it in our hands to make our NHS once again a service admired around the world. Although the challenges that it faces are substantial, they are also predictable. If the Government had listened to those who questioned their cuts in training, the impact of pension reforms on GP retention, the impact of GP shortages on A&E departments and the impact of care cuts in the poorest areas on our health service, we would not be facing the crisis that we face today. The call for further action on A&E waiting times and investment in our care system cannot be ignored.
The Government seem to be presiding over the managed decline of our NHS, but the scale of this crisis will engulf them if action is not taken now. It means old people struggling to cope, it means the disabled being left in their homes rather than being able to take advantage of things that we all take for granted, and it means people being sent home from A&E departments to die. We must do better.

Henry Smith: There is no NHS A & E waiting crisis in my constituency, because there is no A & E unit. It was closed a dozen years ago by the then Labour Government, and people who need to access emergency services must now travel nearly 10 miles on single-carriageway roads to East Surrey hospital. That is the legacy of the Labour Government in my constituency.
I am pleased to say that since 2010 services have been returning to Crawley hospital as a direct consequence of the protection and, indeed, enhancement of the health budget to which the Government have committed themselves, and to which they are still committed. I know that this is often dismissed by the Labour Opposition and by others, but it is quite significant that the NHS asked for an additional £8 billion for the coming period and the Conservative Government are delivering £10 billion of extra investment. That has a very real effect.
I do not deny that there are huge pressures on our health service. As many Members have pointed out today, we have an ageing and a growing population. It is fortunate that people are living longer because new drugs are available to treat conditions that were previously not very treatable, but that puts additional pressure on the health service, although, in a way, those are nice problems to have.
We should not use this issue as some sort of political tit-for-tat. Concern for the health service and our wellbeing is felt by us all, both for ourselves and, of course, for our families and loved ones. I think that, when discussing how to address the increasing health needs of our nation, we should focus on constructive arguments rather than the political point-scoring of which we have heard so much today. I have to say that, as other Members have mentioned, in the 33 minutes of the shadow Health spokesman’s speech we did not hear a single policy suggestion on how under a Labour Administration there would be a different approach to the NHS.
I am delighted to say that Crawley this week celebrates the 70th anniversary of being designated a new town. One of the most disastrous decisions in those 70 years was the loss of the A&E in 2005, although, as I have said, some services are returning. Just yesterday a new clinical assessment unit was opened that seeks to do precisely what we have been discussing: take pressure off A&E whereby those who should not be treated in an emergency environment are triaged and signposted to better support services. That unit is to be welcomed. In recent years, a new 24-hour, seven-day-a-week urgent care centre opened in Crawley hospital as well as an out-of-hours GP surgery. As we strive to achieve that 24/7 NHS, all of these steps are ways we can better serve patients and relieve pressure on emergency care in the whole system, which almost every winter comes under additional strain.
I will support the Government amendment this evening, because we need to recognise the hard work done by our NHS staff and the additional investment. This is not just about funding, however; it is also about the way we deliver healthcare in an acute setting when people present.
Finally, I want to touch on social care, because, of course, health and social care are inextricably interlinked. We have an ageing population, as many Members have  mentioned, and it has increasing health needs. One of the areas of increased health need is dementia, and I am pleased to say Crawley was one of the first designated dementia-friendly towns. That is not just a label; it means multi-agency working between health and local authorities, and indeed the voluntary and private sector, to ensure those with dementia are better supported. I am delighted to announce that recently a new ward, the Piper ward, was opened in Crawley hospital. It is a dementia-friendly ward specifically to better treat the health and social care needs of our elderly population.
I could say much more in this debate, which is of importance not just today but throughout this Parliament, but as we have limited time I will let other Members contribute, too.

Paula Sherriff: First, may I pay tribute to my hon. Friend the Member for Chesterfield (Toby Perkins) for his incredibly moving speech?
People are dying—literally. We are no longer saying people will die unnecessarily; we are now in the present tense, and we are hearing horror stories from around the country of people dying on hospital trolleys and at home waiting for ambulances to arrive. These are lives that could have been saved had it not been for this crisis.
People are dying in hospitals undetected by overworked nurses and other members of our amazing medical staff. A constituent of mine went to visit her grandad in hospital and, very sadly, found him dead in his bed on the ward. The overworked nurses had missed the fact that he was at the end of his life and had passed away. He died alone while his relatives were at home, unaware of how seriously ill he was.
I am bemused to hear Member after Member on the Government Benches standing up to defend the Government, when the facts are absolutely clear. They seem to be in severe denial. How can this be normal? How can the Government sit back and say that the solution is to discard the waiting time target? It is not the people who turn up with sore throats who are clogging up the system; it is genuinely sick people who desperately need medical attention.
Another constituent of mine arrived at A&E just last week, only to be told that she would have to wait at least 10 hours to see a doctor. That is not good enough. We are one of the richest nations in the world. It transpired that she had sepsis, a potentially fatal illness, and it is only because an overworked and stressed triage nurse recognised her symptoms and immediately instigated treatment that she is alive today and is able to tell me her horrendous story. Her treatment was started in the hospital corridor, where she sat on a chair while on an intravenous drip, because there were no beds available, not only in that hospital but in any of the neighbouring hospitals in the trust.
The theme is the same from all my constituents who come to me with their horrendous experiences. The doctors, nurses and other healthcare staff are doing absolutely everything they can. They are on their knees. No one wants to blame them, because they can see that what is being asked of them is far beyond what anyone would ever be asked to do in any other profession, but they can all see that the system is at breaking point.  Instead of berating the Red Cross for suggesting that our NHS is in the midst of a humanitarian crisis, let us stop for a moment and think about why it had to use that term. Let us talk about what we can do.
We owe our incredible junior doctors so much, and they have been treated appallingly recently. A friend of mine recently attended an outpatient appointment at our local hospital and mentioned to the overworked junior doctor that I was an MP. He pleaded with her to tell me how bad things were, how overworked they were, how the NHS was crumbling around us, and how he and his colleagues could not perform to the best of their abilities due to the horrendous pressure they were under. He talked about working 12 to 14-hour shifts with a 10-minute break. He told her that he loved his job, saying that it was a vocation, never just a job. He said that he was proud of this country and its national health service, and that the only thing that kept him working here instead of fleeing abroad, as many of his friends had done, was that he cared so much for his NHS.
When is the Secretary of State going to stand up and take responsibility for what is going on? People are waiting hours for ambulances and waiting for hours in A&E. They are being treated on trolleys in seminar rooms and in corridors. Where does this end? We are already seeing the creeping privatisation of our NHS, with companies such as the dreadful Virgin Care putting profits before patients. Perhaps the end goal is for us to move to an American-style system where people are literally dying on the streets, and where someone turns up at A&E and the first question is, “Have you got insurance, and can you prove it?”
My constituency is served by two hospitals: Dewsbury and District hospital and Huddersfield royal infirmary. Both are due to be downgraded, losing vital services and beds as their respective trusts struggle to meet the financial pressures that have been placed on them. One of the hospitals that is supposed to pick up the resulting demand from the downgrades, Pinderfields hospital in Wakefield, was last week warning people against attending its A&E, and this is before the downgrades have even taken place. I am in absolutely no doubt that if the downgrades go ahead, lives will be lost. I plead with the Ministers and the Secretary of State to stop those downgrades now and to bring forward the much-needed funds that could save the lives of my constituents. It was interesting to hear the Prime Minister refer to those hospitals today at Prime Minister’s questions. She said that there were two hospitals in the trust. Perhaps someone could pass on to her the fact that there are three.
I have quoted Nye Bevan, the founder of our great national health service, before, but I feel that this is more relevant today than ever. He said:
“The NHS will last as long as there are folk left with the faith to fight for it.”
As those on the Conservative Benches appear to have lost faith and stopped fighting, it is our duty on the Labour Benches, now more than ever, to step up that fight. I would not like to speculate about when a Government Member last set foot in an NHS hospital outside of an official visit—[Interruption.]

Henry Smith: Between Christmas and new year.

Paula Sherriff: I thank the hon. Gentleman for his intervention. Perhaps he should show some more empathy for the patients who are waiting on trolleys for up to 10 hours just to be seen. One thing I know for sure is that many thousands of my constituents rely on such services every day and the message from them is unequivocal: the NHS needs funds, and needs them now.
I was admonished by Mr Speaker today for berating the Prime Minister during PMQs, but let me be absolutely clear: I will continue to do that while this mismanagement of our national health service is ongoing. I will never, ever stop fighting for our NHS.

Maria Caulfield: I appreciate the opportunity to speak in this debate. For the record, the last time I was in an NHS hospital was when I was working a night shift on Saturday. I declare an interest in that I am a nurse who has worked during this year’s winter crisis, but I have also worked during winter for the past 20 years.

James Heappey: I apologise for intervening so early in my hon. Friend’s speech, but the hon. Member for Dewsbury (Paula Sherriff) is too busy congratulating herself on her own speech to note that my hon. Friend was working in an NHS hospital on Saturday night.

Maria Caulfield: I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.

Rosena Allin-Khan: Will the hon. Lady give way?

Maria Caulfield: I will not. I must make progress and others want to speak.
It was not unusual for my hospital to declare a major incident because we could not take any more patients. It was not unusual for us to take on the extra work when neighbouring hospitals declared major incidents. The truth hurts, but that is what has happened over my 20 years of working in the NHS and what has happened over the past few days of this winter crisis. It outrageous for Labour Members to suggest that it is something new. They are in denial if they believe that it has not been happening for many years.
The Labour Government was so fixated on the four-hour rule that managers used to bully us and tell us which patients would get a bed based not on clinical need, but on the need to meet a target that was about to expire. I want to tell the House a story. One night I was working in a busy A&E when an elderly gentleman was admitted. He had fallen at home and broken his hip and had to be nursed on a trolley in the middle of a busy corridor.  The four-hour target was looming, and at three and a half hours he called out to me and said, “Nurse, I desperately need to go to the toilet.” I had no cubicle to put that man in. He could not get off his trolley owing to his broken hip. The best that I could do under that Labour Government was to wheel a curtain around him and he went to the toilet there in the middle of a busy hospital corridor, with his war medals on his chest. Now, he got to a ward within four hours—his target was met—but that was not good care. If Labour Members think that it was and think that this is a new problem, they have buried their heads in the sand.

Rosena Allin-Khan: Will the hon. Lady give way?

Liz McInnes: Will the hon. Lady give way?

Maria Caulfield: I will not.

Lindsay Hoyle: Order. If the hon. Lady wants to give way, she will. Unfortunately, she is not, but Members cannot just stand there—two at once—shouting all the time. It is recognised that if a Member is to give way, they will, but it is up to them.

Maria Caulfield: These problems are not new. I have also worked in out-patient settings where A&E targets have had an impact on patients waiting for elective surgery. The sheer determination to meet those targets due to pressure from the Labour Government led to patients with breast cancer having their elective operations cancelled time after time owing to emergency admissions. I had to tell a young mum, whose mastectomy operation following breast cancer had been cancelled three times while her young family were waiting for Christmas, that the only bed we had left was in a post-natal ward, where she woke up and recovered from her operation next to young mums learning to breastfeed. That was in an attempt to meet four-hour targets, so do not tell me that services have reduced. Targets were met, but staff were put under severe pressure not with quality of care but with targets in mind. I make no apologies in making that clear.
I am a supporter of four-hour targets. I was enthusiastic when they were introduced as a way of monitoring performance and improving the service, but they became the absolute king, above everything else. I congratulate the Secretary of State on introducing the consideration of outcomes. What happens to a patient when they are admitted? If they have to stay for four-and-a-half hours to avoid admission or to get full care, what is the problem with that? If they can leave within two hours because they have been adequately treated, fantastic, but we should not be held to account by an arbitrary four-hour rule that has no clinical significance. I support the four-hour rule, but there are other measures that we also need to be aware of and that should be treated with equal status to the four-hour target.
Of course money is important. As our ageing population, and our ability to treat more patients, grows, we will need more funding for both healthcare and social care. It is worth noting that the trusts either side of my constituency receive the same funding and look after the same types and numbers of people. One is in special measures, is unable to deal with its discharges, has queues and is unable to meet its four-hour targets; the other, five miles along the coast, is rated outstanding,  does not have the same pressures or four-hour waits and is able to discharge its patients speedily. There is something about what happens to the money, as well as about how much the money amounts to.
Labour did put huge amounts of money into the NHS over the years, but much of it was squandered—£10 billion on a failed IT project that never saw the light of day, and PFI deals that are still costing the NHS £2 billion a year. How much could be done with that £2 billion?

Daniel Poulter: Will my hon. Friend give way?

Maria Caulfield: I will take one brief intervention.

Daniel Poulter: I commend my hon. Friend for making a balanced speech and for rightly saying that meeting targets does not necessarily equate to delivering good healthcare, although they do have their place. Does she agree that one of the biggest challenges is the consistent inability of a number of A&Es across the country to recruit middle-grade doctors? That is one of the biggest problems that has not been addressed to date.

Maria Caulfield: I absolutely agree that there is a problem in recruiting staff, particularly in the south-east—including in my constituency—in all healthcare professions because it is an expensive place to live. I agree that there is an issue with recruitment but, if we are to move forward, we need to work in a more cross-party way. Continually using four-hour targets as a stick to beat the Government with does nothing for cross-party working, so we need to stop the political cheap shots and recognise that money is not always the solution—it is about how the money is spent and the difference it can make. This also has to be clinically led. We can work together as politicians, but if we do not work with healthcare professionals, in both primary care and secondary care, I fear that we will be sitting here again in the years to come to talk about another winter crisis.

Norman Lamb: I join many others in commending those who work in our NHS and in our care system, including the hon. Members for Lewes (Maria Caulfield) and for Central Suffolk and North Ipswich (Dr Poulter) both of whom continue to work in the NHS, I think without payment—[Interruption.] Not any longer. It is important that we acknowledge that many people in the NHS are working under incredible strain, and we owe them a debt of real gratitude.
I make it clear that I support the Labour motion, and I recognise the importance of access standards in our health service. After arriving here in 2001, my first Westminster Hall debate was on waiting time standards in Norfolk for orthopaedic cases. People in those days were sometimes waiting three years for treatment. So the waiting time standards that were introduced dramatically changed people’s experience of healthcare, and we should celebrate that. But it is also right to say that sometimes the standards distort behaviour, and those distortions need to be addressed, as the hon. Member for Lewes made clear. Another example to cite is that of the ambulance standards, where I am concerned about a  very serious distortion of behaviour, which often causes enormous frustration for paramedics, who are also working under ludicrous amounts of pressure.
The other point I wish to make on access standards is that although I totally applaud the Labour Government for introducing them, they did not introduce them for mental health. That is why we now have to complete the picture. This Government have confirmed that they accept in full the Paul Farmer taskforce report on mental health, but it includes the proposal to roll out comprehensive maximum waiting time standards in mental health, so that someone with mental ill health has exactly the same right as anyone else to get access to good-quality, evidence-based treatment on a timely basis. We put this in an amendment that we tabled for this debate but which was not selected, but I urge the Government, as they have accepted that report, to make sure it is now implemented. The current situation amounts to a discrimination in the health service; how can we possibly justify the fact that someone with mental ill health does not have the right to timely treatment which other people enjoy? We have to end that discrimination.
The final thing I wish to address relates to the question I asked the Prime Minister today. I asked her to meet a group of cross-party MPs who are proposing that the Government should establish what we are calling an “NHS and care convention”. We feel that is an opportunity to engage with the public in a mature debate about the scale of the challenge we all face. We can trade insults across this Chamber, but we all know in our heart of hearts that the system is under unsustainable pressure—that is the truth of it, and we know it. At some point, as the hon. Member for Lewes conceded, we will need extra resources in the future, so let us plan now. Let us get everybody on board and get cross-party support, because sometimes, just as we saw with Adair Turner in the last decade under the Labour Government, we need a process to unlock a problem that ordinary partisan politics has not been able to resolve.
I welcome the fact that the Prime Minister agreed today to meet a group of us who are making this call. We have also set up a petition on the Parliament website so that any member of the public can join this call. I urge hon. Members from across this House who support this call to join in, because not only is it in the Government’s political interest to do this, but it is fundamentally in the interests of the citizens of this country that we in this House collectively address an enormous existential challenge to the NHS and the care system. We surely cannot tolerate more than 1 million older people not getting access to the care and support they need. I do not want to live in a country where someone’s access to care and support in old age depends on whether they can pay for it, but we are at genuine risk of slipping towards that situation. If we all believe that that is not tolerable, we have a duty to act. We must be prepared to act together, not just trade insults at each other. There is a real opportunity now to do what the public are desperately pleading for us to do: bury our differences and work together to achieve a long-term, sustainable settlement for the NHS and the care system.

Derek Thomas: There is no doubt in my mind that the meaningful integration of health and social care is the most important issue facing the NHS  today. The most productive way to address the issue of bed-blocking is by integrating services, pooling resources, and dramatically raising the profile of and support for community health professionals and care and support providers. We often hear of the problems facing the health services, but I am going to try to concentrate on the solutions.
Last November, I set up a local inquiry, identifying a number of people across the constituency and getting them together to investigate what health and social care could and should look like in west Cornwall—this is all part of the STP process in Cornwall and the Isles of Scilly. Together we are asking that question of representatives of health and social care providers. We are talking to GPs, NHS providers and managers, health campaigners, care providers, day-care managers, pharmacists, mental health clinicians, hospital matrons, Age UK and others—I am even including my predecessor in the discussions. All the clinicians we have met have identified savings that can be made through integration that they believe would improve patient care.
The results of the local inquiry will set out clear recommendations to be considered as part of the sustainability and planning process in Cornwall and the Isles of Scilly; however, it is clear from the evidence we have heard that extra funding will be required to implement the planned transformation. The health services in Cornwall and on the Isles of Scilly already have a deficit that runs into tens of millions of pounds. Delivering rural health services is an expensive and under-funded exercise in Cornwall and the Isles of Scilly, and we in that part of the country long for a fair funding agreement for health and social care. People in my constituency agree that we must integrate health and social care. They also agree that extra funds are urgently needed to fund that integration.
In the autumn statement, the Chancellor confirmed Government plans to continue to increase the tax allowance threshold for workers. I completely agree with efforts to lower the tax burden, but my constituents have asked me to look at how we might raise taxes to help the integration of health and social care. On that basis, would the Government consider pausing the increase announced in the autumn statement and using the revenue generated to fund the transformation of integrated services? That could provide just shy of £6 billion over the rest of the Parliament to help health and social care providers to make the improvements they need and to reduce costs in the long run, while improving patient care.
One example of where extra funding would have dramatic results is if the pay and support for care and support workers was increased. In west Cornwall, some community care workers are paid as little as £7.20 per hour, yet they do incredibly important work in keeping people at home and in safe and good conditions. Because of such low pay and the pressure on care workers, we struggle to recruit and retain such valuable employees. Were we to look at pausing the increase in the tax allowance threshold for just a short time, the money saved could help to integrate the services to which we are all committed, thereby helping to make the savings and improvements in patient care that we all want to see.

Sue Hayman: The Government say that their success regime for the NHS in Cumbria is about transforming health and social care to create a
“centre of excellence for integrated health and social care provision in rural, remote and dispersed communities.”
That sounds fantastic—it sounds like exactly what we need. If that is the case, though, why are local people are so concerned about the actual proposals that there is a petition for a vote of no confidence in the regime? Why did the Secretary of State himself say earlier in the debate that he has profound concerns about the quality of care in Cumbria?
West Cumbria is set to see rapid population growth, owing to the proposed nuclear new build at Moorside, alongside proposed coal mining and tidal energy projects. There are concerns that none of this is being taken into account. Nevertheless, I shall focus on my particular concerns about the proposals for maternity services and community hospitals.
First, on maternity, the highly skilled and experienced midwives in west Cumbria have told me that the success regime’s preferred maternity option is not their preferred option. The idea behind the success regime is to
“bring more care closer to home”,
with a model that would
“ensure provision of safe, high quality care and provide a first class experience”.
But the midwives ask how that can be achieved through the proposals to change maternity care at West Cumberland hospital when the success regime’s preferred option sees the choice of birthplace removed from hundreds of women and would potentially see severe delays in women and babies receiving life-saving assistance. The clinical outcomes and satisfaction rates at West Cumberland hospital under the current maternity care system are excellent, and show that safe, high-quality care is being provided. The proposed changes would bring inequality, preventing fair access to maternity services across the county, and discriminate against west Cumbrian women who would no longer have a choice in maternity care, particularly those who are vulnerable owing to deprivation and social isolation.
The proposals will mean that around 700 additional women will deliver their babies at Carlisle every year, but where will they be cared for? The Cumberland infirmary in Carlisle already struggles with its current workload. West Cumbrian mothers need proper answers on this. In addition, a proposed new garden village is to be built south of Carlisle with 12,000 new homes. How on earth is the Cumberland infirmary expected to cope?
I am particularly disappointed that there is no option in the current consultation document to keep beds at Maryport and Wigton community hospitals. All the proposals remove all the beds at those hospitals. This will be particularly difficult for the relatives of patients who are having end-of-life care, because they may be elderly and have their own medical conditions. With no transport of their own, travelling to visit family members can be particularly arduous.
Both hospitals serve areas with considerable deprivation and very poor local transport links. Patients and families in Maryport may have to travel to the community  hospitals or the acute hospitals. Journey times would be long with poor bus links, making it difficult for elderly and disabled people.
The people of Maryport feel very strongly about the changes and have run a passionate campaign to show people involved in the success regime just how much the community hospital means to them and how it is an integral part of the local community. They are deeply upset at the removal of the beds.
It is imperative that all services are delivered as close to people’s homes as possible. This must include the retention of beds at all our community hospitals and the retention of consultant-led maternity services at West Cumberland hospital.
I shall finish with a very personal experience, which relates in particular to beds in community hospitals. Not long before Christmas, my father was taken seriously ill. We managed to get him transferred from the acute hospital to his local community hospital, which was within walking distance of his home. He knew the staff at the hospital, and the district nurse was able to call in to see him. When it became clear that he was at the end of his life, we tried very hard to get him moved home—we had a hospital bed set up in the living room. Unfortunately, the move was not possible. However, unlike the experience of my hon. Friend the Member for Chesterfield (Toby Perkins), my father had a good death in his community hospital. All my constituents should have the same opportunity that my family had. We were able to be with my father at the local community hospital where he knew the staff and the district nurse who came to see him. If we remove palliative care from our community hospitals, we will be making a terrible mistake.

James Heappey: The Wells constituency faces some real challenges in healthcare. We have an ageing population, and demand for the local NHS is growing rapidly. There is no doubt that our primary healthcare system is under considerable strain, as is our adult social care system. Our hospitals, too, face record demand. However, to call this a crisis does a disservice to those in the clinical commissioning group and our local hospital trust who have worked so hard to prepare for the incredible challenges that they face this winter.
Demand in the four A&Es that serve my constituency was significantly higher in the week between Christmas and the new year than in the same week the previous year. In two A&Es, demand almost doubled. I know that the A&E staff had to work extraordinarily hard to meet that demand and I know, too, from some constituents who contacted me that some people were not seen within the time that they might expect. However, I have heard from others who arrived at A&E expecting bedlam, only to be seen in well under four hours. Indeed, during last year’s Christmas recess, I spent the early hours of Christmas eve in Weston General hospital’s A&E with my then three-year-old. Like this year, the Labour Front Benchers were claiming crisis, yet I saw some incredible clinicians doing an incredible job well within the required timelines. Moreover, an outpatient appointment needed in the week between Christmas and new year was easily arranged and kept. My personal experience is just one of the millions of experiences within our NHS each year, but I highlight it because if we are to have an honest, factual debate about our health system, we should  caution against the emotion of individual experiences, for there will always be at least one that illustrates whatever point we seek to make.
Further into the hospital system, three of the four hospitals that serve the Wells constituency had more beds available in the last week of 2016 and the first week of 2017 than they did in the corresponding period in the previous year. Although occupancy at Taunton and Yeovil was 81% and 82% respectively last week, it is true that occupancy in Bath was 93%, and in Weston-super-Mare 100%. Make no mistake: occupancy levels such as those are a cause for real concern. But it is also important to note that although things are tight, so far the trusts are managing. However, I know that in all four of those hospitals, particularly in Weston, far too many beds are blocked by those who would be discharged if care at home could be arranged.
The Government have made more money available for adult social care and have given councils greater flexibility to increase council tax in the interim, but Somerset County Council and our local NHS organisations are justifiably still very concerned. I encourage the Government to look again at the local government funding settlement and adjust it to ensure that the funding gap between urban and rural areas does not widen, and that funding for adult social care clearly and fully reflects the places in the country where the demographic is most top-heavy and where rurality increases the costs of delivering that support.
Finally there is the challenge that we face locally in primary healthcare. Local practices have assured me that anyone requiring an emergency appointment is seen on the day. However, it is true that my constituents are too often expected to wait a week or more if they ask to see their regular GP. Quite understandably for those with longstanding and complex health issues, they expect to see the doctor they know, so these waits are unacceptable, but it is wrong to connect the waits solely with funding. The greater challenge in Somerset is not the primary healthcare budget, which has risen for each of the past three years, but our ability to recruit new GPs.
The Secretary of State has worked hard to deliver more GPs into the whole system, but now rural CCGs such as Somerset’s will need to look at what initiatives could be developed to encourage new GPs to ply their trade in rural general practice. Furthermore, we must listen to and support those responsible for our STPs. We have called again and again for politicians to keep our noses out of NHS planning. Now that we have and local clinicians are now at the helm, the Opposition dismiss their work as well because it is politically expedient to do so.
The STP in Somerset has been written by people who really know their craft. When I asked them whether they would have written the plan as it is, even if there were no resource constraints, they told me that they would. They say that the demand has changed and that the thinking on public health has changed, and they tell me that the clinical view of how and where people should recover after they have been in hospital has changed too. Things will change still further over the years ahead.
Some of the things that the STP proposes are very challenging to me and some will be very unpopular with the community I serve, but the analysis is based on an  expertise that far outstrips mine, so unless I am being implored now to reassert the supremacy of politicians in these matters—we have, after all, apparently had enough of experts—I think we owe it to the clinicians empowered to now design and run our local healthcare systems to scrutinise, of course, and to support them. Moreover, those clinicians deserve to do that work without the partisan hullabaloo being stirred up by the Opposition. Our inboxes give us a great feel for how things are. Our conversations with constituents, clinicians and patient participation groups, such as the one in Cheddar that I will see tomorrow night, shape that view too. To claim that all is perfect right now is not true, but to claim that there is a crisis is not true either. Our population and the practice of medicine are changing. This debate needs to happen—not in a partisan furore, but in an honest, constructive and supportive way.

Thangam Debbonaire: I was going to speak about the effects of cuts to health and social care funding on hospitals and healthcare in the south-west, but all the things I wanted to say have been eloquently said by other hon. Members. So, in keeping with other speeches I have made recently, I have decided not to repeat what has already been said, to scrub all of that from my speech and to talk about something completely different: the health consequences of loneliness in older people; the impact of funding cuts to NHS and social care systems on loneliness; and the impact of older people’s loneliness, in turn, on the healthcare system.
In the run-up to Christmas, I was regularly blinking back tears on the underground whenever I saw the advert from Age UK, which I am sure many hon. Members will have seen, which had the slogan, “No one should have no one at Christmas”. For Members who might not remember it, it looked something like the Age UK report “No one should have no one”, which I have here and which I re-read yesterday. It was published in December last year and is about loneliness in old age. Reading that report brought home to me just how much loneliness affects older people and how funding cuts that may appear small and insignificant can have a cumulative effect on older people.
A constituent illustrated that to me recently when she came to talk to me about her worries for the older people she cares for as a very low-paid care assistant. She was not complaining about her pay, by the way—I am just making that observation. She told me that she regularly stays well beyond her low-paid hours because she feels the people she is working with need her. That is partly because they have greater care needs than can be dealt with in the time allowed, and also because they are lonely. As I said, she was not complaining, but if we starve social care of funding, people such as her will be subsidising the health and social care system. She is doing that voluntarily, but things should not be left to chance like that.
The Age UK report mentions the survey that it carried out of 1,000 GP practices as part of its campaign in 2013 to end loneliness, which found that nearly 90% of GP practices felt that some patients were coming in because they were lonely. The report also points out that funding cuts mean that meals on wheels, day centres,  libraries, community centres, lunch clubs and public toilets have been cut or closed in recent years. It points out that all of that decreases the opportunities for older people to get out, socialise, take care of their health, eat well and exercise, which increases their loneliness and isolation and damages their health.
What does that have to do with chronic serious illnesses? Age UK carried out an evidence-based review for its loneliness report, and it found that chronic loneliness increases the risk of serious illnesses such as diabetes, stroke, depression and dementia, as well as making it much harder for people to get out and receive help or do things that might prevent those conditions from getting worse, such as exercise or having a good diet.
I pay tribute today to all the people across the country who give their time as volunteers, staff and fundraisers for charities such as Age UK nationally and locally, and in Bristol, for Bristol Ageing Better, which does so much to combat loneliness in older people.
Let me read one example from the Age UK report:
“Arthur’s son was worried that his health was deteriorating because of the many hours he was spending alone in his flat in sheltered accommodation. He was unwilling to participate in group activities because of difficulties hearing. He had had a busy social life, but most of his friends had died...Age UK introduced him to Paul, who had had to retire early after an accident and was feeling increasingly isolated...They play dominoes and cribbage. They dissect the latest football match and reminisce about their time in the building trade—swapping funny stories of mishaps and adventures. Paul has provided Arthur with good company and a ‘link’ back to the job he loved. Arthur has helped restore Paul’s sense of purpose and self-worth.”
That example, and the many others in the report, show just how much work on loneliness can help to improve older people’s health and to reduce the costs on our health and social care system.
It is vital for the Secretary of State to address what the CEOs and staff in NHS hospitals and primary care in my area have told me about the impact that cuts to social care have on delaying discharge from hospital, and I hope that he does so. I also want the Minister to tell us exactly how he and the Secretary of State are going to lead the way in providing us with a fully integrated and fully funded health and social care and mental healthcare service.
I want us all to read Age UK’s report and follow the recommendations that it makes for MPs, among others. It asks Members of Parliament to
“Find out…about loneliness among older people in your constituency…raise awareness…Become an Age Champion”,
and to encourage our own political parties to do more. It asks us to
“Take steps to put loneliness in later life on the Government’s agenda”—
I hereby do that—
“and hold them to account for progress”,
which I will continue to do. It asks us to
“Make the case for investment in local community resources to support sustainable, long term action to help lonely older people, wherever they may be.”
I urge the Government to take note of that. Finally, it asks us to:
“Support the work of the Jo Cox Commission on Loneliness”,
which is launching shortly. I would like us all to take those words to heart.

Helen Whately: It is a pleasure to speak in this debate and to follow hon. Members who have made very thoughtful contributions. The hon. Member for Bristol West (Thangam Debbonaire) spoke about loneliness, which is a problem across the country, and the very important work that is being done on that. It is also a pleasure to follow colleagues who have spoken about their personal and family experiences. My hon. Friend the Member for Wells (James Heappey), the hon. Member for Chesterfield (Toby Perkins), who is no longer in his place, and the hon. Member for Workington (Sue Hayman) spoke about their experiences, both good and bad, of the national health service.
I, too, have personal experiences both good and bad. Three years ago, I spent Christmas day night in A&E with my son, who was five at the time, and who had his appendix taken out first thing in the morning on Boxing day. He had absolutely exemplary care and was home within two days, eagerly making up for the quantity of sausages that he had omitted to eat on Christmas day because of his tummy ache. Last Christmas, my grandmother, then aged 100, was in hospital—she was there for several months—and she had a much, much worse experience; it was not the NHS at its best. We all have good and bad experiences to draw on. We hear from our constituents, as well, about these good and bad experiences. It is important to recognise what the NHS does well, and is doing well, but also where the system is failing, and to focus on supporting the good and tackling the bad.
I very much understand why this debate has been called, because there is no question but that the NHS is under extraordinary pressure this winter. We have heard that last week it had the busiest week ever. However, I am quite disappointed by the tone of some of the contributions and more significantly by the lack of proposals from those who just said that that there is no money and made no suggestions as to where the money will come from. That is fundamentally unhelpful.

Barbara Keeley: It is very clear where the money is to come from—we are asking for £700 million to be brought forward from the better care fund from 2019. It is already allocated.

Helen Whately: I appreciate the hon. Lady’s point, but bringing money forward still requires it to be found. This is set against a backdrop of Labour, in 2015—less than two years ago—not committing to fund the NHS with the money that it was asking for, as this Conservative Government are now doing. Labour is in rather a shocking position.
I want to seize this opportunity to say a very heartfelt thank you to all members of NHS staff—nurses, doctors, allied health professionals, porters, care assistants—and those in social services, particularly those in and around my constituency in Kent, who I know are working extremely hard to deal with the pressure on the frontline. I also thank patients and their families who are being thoughtful and taking care to make the best use of the NHS.
We know that there is great variation in how the NHS is coping. I have just been told that the waiting time in Maidstone A&E is—as we speak—only 37 minutes, so Maidstone is coping pretty well right now, but at the  nearby William Harvey hospital in Ashford it over four hours, so there is variation. I do not say that so that people listening can divert from where they are going; there may be a case for that and for greater transparency, but that is for another day.
We talked earlier about money. There is no question but that this issue is partly about the need for more funding and more staff, but the Government are doing exactly that: they are giving the NHS more money and investing in significant increases in the workforce. However, money is not the whole answer. If the NHS just continued doing all it does in the way that it does without any change, we would find ourselves with a system that was unaffordable and that used a proportion of GDP for which there would not be public support. We know that we have an ageing population—people are living longer and have multiple complex conditions—and that high-cost treatments are becoming available that people want, so the NHS itself recognises that this is not just about more money but about changing the way in which services are delivered.
Such changes are being worked on and are actually happening at the moment. Earlier today, I spoke to the hospital trust chief executive who is the lead for the Kent and Medway sustainability and transformation plan. STPs have come up several times today. As I have seen, under him and the group around him, there has been a coming together across Kent and Medway of NHS organisations that have not tended to work closely together. The coming together of the NHS and social services is so important, so necessary and so right if we are to work out how to provide a better health service in a more sustainable way. We need to break down the barriers between organisations as it just does not make sense to have a split between the NHS and social care in who provides what. We should look at how we can genuinely move care out of acute hospitals and closer to home, which we know is good for patients. It is exactly what the hon. Member for Workington hoped for her father and what we wanted for my grandmother as she neared the end of her life.
We need to enable people to be looked after closer to home or preferably at home, and to improve prevention and—I feel particularly strongly about this—mental health care. The Prime Minister has taken a personal lead on mental healthcare with her announcements on Monday. In the light of the pressure on A&E, I particularly value the commitment to psychiatric liaison in A&E departments, which we know is helpful in the prevention of suicide, is good for people who go to A&E with mental health problems and helps A&Es look after the people who need to be seen for physical health problems. I welcome the fact that my area of Kent is looking at bringing that forward and having psychiatric liaison in all A&Es by 2018. Really important work is therefore going on at local level.
I encourage Labour Members not to make the knee-jerk or even tear-jerk speeches that some have made, but to take a longer view of the situation. That would help us to have a more mature conversation about what the NHS needs, and to talk about policies and concrete proposals, rather than just about having more money, to solve the problems. It would also enable us to get behind what the NHS is doing at local level, where the NHS and local authorities are coming together to draw up plans across their areas for better care for patients in an affordable and sustainable way.

Rosena Allin-Khan: After four years of having responsibility for the national health service, the Secretary of State for Health has declared:
“We need to have an honest discussion with the public about the purpose of A&E departments”.
We, who have seen his work from this House, and those who have felt the effects of his work on the frontline, know exactly what he means—“Let me tell you why everyone is to blame except for me.”
Earlier this week, the Secretary of State told the UK that nearly one in three visits to accident and emergency do not need to be made. That was his reasoning for weakening the target that every patient should be seen within four hours. That target applies only to people whose condition is serious and urgent enough, so I find staggering the sheer hubris of those comments, the avoidance of accountability in that decision and the danger inherent in both. As an A&E specialist doctor, I have treated patients who arrive in A&E with what seem like minor injuries or illnesses but develop into much more serious and life-threatening issues. The fact that the Secretary of State, both in his words and in that decision, is telling the people of the UK that they should self-diagnose before heading to A&E could have disastrous consequences, for which he would be responsible.
What if, because of the Secretary of State’s words, patients decided to stay at home after a serious bang on the head that turns out to be a life-threatening bleed to the brain? What about a potentially deteriorating case of pneumonia that is not serious enough to warrant being in A&E but eventually results in somebody becoming severely septic and dying?
As a citizen of this country and a patient of the NHS, I find the Secretary of State’s refusal to accept responsibility for the state of A&E departments deplorable. Instead, he blames patients for visits that “do not need to be made”. However, patients do not go to A&E for fun. They go because they are ill and cannot get a doctor’s appointment for two weeks. We have heard today from Members on both sides of the House who have taken their own young children to A&E. Did they do so for fun, or because they felt there was a need for their child to be treated? People go to A&E because their GP does not have resources at their practice, in some cases for something as simple as handing out crutches. They go to A&E because there is something wrong and they are worried sick and simply desperate to speak to somebody professional about their health.

Victoria Atkins: Will the hon. Lady give way?

Rosena Allin-Khan: No, I will not. [Interruption.]

Lindsay Hoyle: Order. Let us just calm it down. Government Members did not give way before, and let us not get into the habit of shouting at each other. Let us have a nice, sensible debate.

Rosena Allin-Khan: Many people who go to A&E know that they should not be there. I have had elderly patients saying to me, “I’m so sorry, doctor, for wasting your time.” But what other option are the Government leaving them? That is what we are debating today. The Secretary of State wants an honest conversation—well, let us have it. Let us talk about the impact that the current state of  the national health service, which he has been in charge of for four years, is having on accident and emergency departments and throughout hospitals in this country. Let us talk about rock-bottom staff morale. Let us talk about the breakdown of staff marriages, a rise in depression among staff and the fact that waiting times are not the responsibility of patients. They are not to blame.
Rising waiting times are the Secretary of State’s responsibility, yet he blames them on the number of people going to A&E since the target was set. It is his responsibility to lead a national health service that can meet the needs of its people, but again he pleads innocence. He says that no other countries have such stringent targets, suggesting that it is unfair that we do. The meeting of the A&E target in particular, not watered down but in full, is what establishes the NHS as the best health service in the world, and one that we can, should and would be proud of under a Labour Government. After all, emergency departments’ ability to meet the four-hour target is directly related to the health of the NHS itself. It is simple: more people go to A&E when they have no other options available.

Sue Hayman: On those options, the use of A&E in my area of Cumbria is entirely down to the lack of GPs. With so many GPs reaching retirement age, the situation is only going to become more acute. Does my hon. Friend agree that the Government need to tackle this matter urgently?

Rosena Allin-Khan: I wholeheartedly agree with my hon. Friend. She makes an eloquent point about the lack of GPs and the problems we will face when more retire. Three GPs in my constituency contacted me this week to say that they had been offered jobs that were subsequently retracted due to financial pressures.
The Secretary of State pleads innocence. He says no other countries have such stringent targets. We should not compare ourselves to the worst; we should be leading as the best. The explosion of waiting times is his failure and a sign of the dangerous erosion of one of the country’s greatest institutions. As we saw last week when the British Red Cross had to be drafted in to our hospitals, our NHS is in crisis. Yet instead of listening to doctors and fixing the systemic problems they have created, our Government are repackaging the A&E four-hour target to try to save face and take attention away from the real challenges: the challenge of social care packages not being in place, prohibiting flow through A&E departments; the lack of access to GPs across the country, making A&E the only resort; the chronic underfunding and significant cuts in funding at local authority level; doctors and nurses being forced to miss breaks, as we heard earlier today, and working 14 hours, some without a break, sleep-deprived and unsafe to practise clinical work; and an NHS staff who do not feel supported, encouraged or motivated by the Government. None of these things will be addressed by a watered down four-hour target.
Having spoken to the Royal College of Emergency Medicine, those working on the frontline at all levels, and those who are training our junior doctors, I would like to put forward questions for the Secretary of State to think about. Why has it been decided that the four-hour target will now be downgraded? Who has been consulted on that? Which body said it would be beneficial to  patients and A&E staff across the trusts? How will he define major and minor health problems? How are doctors and nurses magically meant to know, at first sight without proper assessment, whether it is a major or minor health problem? Who is responsible if a seemingly minor condition is actually life-threatening? Will it be him? Who will be responsible? How will the Government explain that we will be going back to the days when patients could wait over 12 hours if they were not considered ill enough?
The Secretary of State must recognise the impact of this systemic crisis on A&E rooms across the country in his words and in this decision. To downgrade the target, the Secretary of State does neither, instead placing blame on patients and putting patients at risk. Let me tell it straight: I have been an A&E specialist doctor under a Labour Government and under a Conservative Government. There has been a change under this Government—and for sure it has not been for the better.

Lucy Allan: There have been very many excellent and constructive contributions to this debate. I welcome the valuable input from those who have real life experience in the NHS. In particular, I congratulate my hon. Friend the Member for Lewes (Maria Caulfield) on her excellent speech. It was very disappointing indeed to see an Opposition Member behave with such disrespect for a fellow Member during that speech. We all owe a debt of gratitude to those on the frontline. None of them would thank us for reducing this debate to an ill-tempered party political act of posturing.
I know there are many sensible Opposition Members who fully understand that no complex problem is ever solved by just increasing funding in response to ever-increasing demand. There are some very strong Opposition Members who want to work in a constructive fashion with Members across the House to tackle the challenges our NHS faces. I welcome that. The right hon. Member for Don Valley (Caroline Flint) is one such sensible Member. She made a point earlier this week, on the BBC Radio 4 programme “Westminster Hour”, that it is not even electorally advantageous for the Labour party to treat the NHS in the way it so often does—we have just heard an example of it. It is for the benefit of all our constituents that we must all encourage a more constructive approach.
The four-hour target was introduced for those with urgent health problems. I am sure that all Members agree that those in need should get access to care as soon as possible, and not find their needs eclipsed by someone with a minor ailment just because targets must be met. The Secretary of State has spoken this week about his commitment to protecting the four-hour promise for those who need it, and he is absolutely right to say this, because today, if we talk to those who work in our local A&Es, as all Members do regularly, they often say that there are people going to A&E who do not need to do so, and clinicians will express the desire to be able to prioritise need, rather than simply meeting targets.
As a constituency MP, I fully understand that it can be incredibly difficult to see a GP when one wants to, and it can be equally difficult to navigate the system—ringing at the right moment to get an appointment on the right day—but the answer is not simply to  circumnavigate the system and turn up at A&E to get fast-tracked irrespective of need. We should not be encouraging the expectation that whatever the ailment, no matter what the demands on A&E staff, if someone goes to A&E, they will get seen within four hours. If people are going to A&E who do not need to be there, why are we offering them the four-hour service?
I would be grateful if the Minister told us more about what can be done to tackle this issue. Perhaps he could mention what proposals there are for GPs in A&E or different mechanisms for triaging or managing the expectations of our constituents. What matters most is that those in need get access to the appropriate treatment as soon as possible. That is what the target is for. It must be about safety for those with critical and urgent health conditions.
We must never lose sight either of the fact that our health and wellbeing are often dependent on our lifestyle, and with the right help and support we can all make the right choices to help us live healthy and happy lives. Diet, stress management, sleep hygiene, exercise, alcohol use and smoking are all key determinants of our physical and mental health and wellbeing. I would like a much greater emphasis to be placed on self-care and self-help, because we can all play our part and because no amount of funding will ever compensate for a lack of self-care.
Yes, we need to take a grown-up and honest approach to this incredibly important issue, which matters to all of us who have spoken so passionately today—I respect the passion of all Members on both sides of the House—but we must avoid falling into the trap that some have fallen into today of approaching this debate in a way that lets ourselves and the House down and does not benefit those we most wish to assist. So, yes, let us keep on exploring a sensible and collaborative approach, as articulated so eloquently by the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Totnes (Dr Wollaston), who has echoed the sentiments of others and is doing excellent work in working together across the House. None of us should ever play politics with the NHS; it matters far too much for simple games.

Jenny Chapman: It is a pleasure to follow the hon. Member for Telford (Lucy Allan). I have not heard her speak before, and I look forward to hearing many more speeches from her in the future, but I completely disagree with her implication that we are letting ourselves, the House and our constituents down by standing up and championing health services in our constituencies. It is an essential part of our work and the reason many of us sought election to this place, particularly those such as my hon. Friend the Member for Tooting (Dr Allin-Khan), who has such relevant experience of this subject and made a tremendous speech. I listened with great interest to what she had to say, and I think that Ministers ought to be doing the same.
We have had a lot of debate about whether the NHS is in crisis, and whether it is a humanitarian crisis, an ordinary crisis or a winter crisis. I looked the word up and found that a crisis is “a period of intense difficulty or danger”, which strikes me as a good description of where the NHS is today. Intense difficulty is what I am seeing in my local hospital, and it is what my constituents are coming to tell me about.
I have been an MP for nearly seven years, and I keep track of the topics people come to talk to me about in my local surgeries. I am sure many of us do that; it is not hard to do. Someone comes to see me every week either about an experience at the hospital or, more often still, because of an experience in adult social care. That is not something that has occurred suddenly over the last few weeks; it has been growing over time. I would say that the crisis we are witnessing today has been long predicted and is something that we have all felt happening over time.
The Government have chosen—they made a decision—not to act to prevent the worsening of the crisis, which is why there is such anger on the Opposition Benches. When a quarter of patients wait longer than four hours in A&E, that is a crisis. I do not really care whether they are there with an minor ailment or a more serious one, because four hours is too long to wait. The fact that people are there with minor ailments is a very clear demonstration of the problems that exist elsewhere in the system.
When people cannot get a GP appointment they sometimes phone 111, and, more often than not, they will be directed to A&E. I think we need a selection of services available at a central point, whereby if people need a GP, they can see a GP; if they need a practice nurse, they can see a practice nurse; and if they need to be admitted, they can be admitted.

Victoria Atkins: In an effort to reassure her colleagues, I want to ask a genuine question—one that I would have asked the hon. Member for Tooting (Dr Allin-Khan). What impact does the hon. Lady believe the 2004 GP contract has had on out-of-hours care? This seems to be the nub of many of the issues discussed this afternoon.

Jenny Chapman: The GP contract was changed in 2004, but I did not notice the sort of issues that we face today until far more recently. I am not a scientist or a doctor, but I understand cause and effect, and it does not ring true to say that something that happened six years prior to the change in Government can be blamed for something that is happening six years after the change in Government. I am not saying that there were no consequences, but I believe that ample opportunity has been provided to put measures in place that would have prevented us from being where we are now.
The hon. Lady’s intervention leads me nicely to my next point, which is about the Secretary of State. I had not intended to speak today, but I was so frustrated listening to him on the “Today” programme, trying to blame anybody but himself, that I decided to do so. He has a pattern. The first thing he does is blame the Labour Government, who were in government until 2010. His party has been in government since then, but he will blame Labour for anything he possibly can. He will find something that happened, perhaps at a particular trust and say that that is why something has gone wrong today. If that does not work and cannot be evidenced, he will say, “Well, that particular trust is a basket case. It is the trust’s fault or the fault of the local managers and local clinicians who have not organised themselves right”.
If that does not work, he will then blame the public, and tell them that they are going to the wrong place, accessing their care in a way that he does not think they should. He might call them “frequent flyers” or point to a problem that is the public’s fault. He will say, “They do not look after themselves properly; it is clearly their fault”. If that does not work, he will blame the local council, and I think that is the worst thing that I have heard him do—blame the local authority.

Robert Courts: Will the hon. Lady give way.

Jenny Chapman: In a minute.
My local authority has prioritised adult social care, but the pressures are not going away. They are going to get worse and more difficult to manage—and it is running out of things to cut. It is closing our central library in Darlington and making other hideous cuts, and I do not know where the next round will come from.
I will now give way to the hon. Member for Witney (Robert Courts), if he still wishes to intervene.

Robert Courts: I am sure the hon. Lady agrees that it is incumbent on all of us to discuss the future of our NHS and our healthcare services responsibly. Does she not accept that when the Secretary of State is talking about where people go for their services, it is not a question of blame? We ought to move away from that blame culture. However, there is a benefit in trying to educate people. If their illnesses are not best served by A&E departments and are best served elsewhere, they ought to realise that they should go elsewhere. That would help all of us. It would help the people who are seeking the services, and it would help the people who are providing them.

Jenny Chapman: Yes indeed, so why does the hon. Gentleman not say that to his right hon. Friend the Secretary of State? He is the one who is blaming people, not me. I should welcome a programme that involved explaining to people and making it easier for members of the public, including me, to decide where we should go when we need assistance.
One solution that the Government have come up with seems to involve watering down the four-hour target, although, interestingly, not even Conservative Members seem to be able to agree on—or explain—what change will be made, or even whether there will be a change. Their other solution is to close A&E departments, and, as part of the STP, the A&E department at Darlington Memorial hospital is one of those that may be downgraded or closed. I do not think the local community will accept that. Part of our purpose in doing our job is to give a voice to local communities, but, so far, our local community has been completely shut out of the STP process. We would not have even known what was contained in the plan had it not been leaked by Hartlepool borough council on its website. That is a shocking way in which to conduct a dialogue with a local community.
In parallel with the STP process is the Better Health programme, which started about three years ago and which operates in the region that contains my constituency. I was shocked to discover from responses to parliamentary questions that local health managers had spent £4.6 million  that could and should have been spent on front-line health services for my constituents on a consultation on whether or not to downgrade A&E. I could have spent that money a great deal better, and I could also have told those health managers what the local population thinks about the proposal. They are very angry and upset about it, and it is right for us to express such anger, disappointment, outrage and fears for safety in the House.
Many Members have spoken about their families and relatives today. My hon. Friends the Member for Chesterfield (Toby Perkins) and for Workington (Sue Hayman) spoke about their fathers. My dad died in 1994. He had had a heart condition. He was 48, and I was 20. Since then, I have taken a keen interest in cardiac health and services for people with heart disease. I was shocked to find that before 1997, it was not uncommon for people to die while waiting for heart treatment, and that people would often wait 18 months. The Labour Government changed that: we made it a matter of weeks, and we saved countless lives as a consequence.
When people say that the Labour party did not do a good job with the NHS, and when Conservative Members try to imply that we have a fake, dewy-eyed, sentimental attachment to the NHS, they are completely wrong to do so. We will fight for the NHS. We created it, but we also did a good job running it in government. We saved lives, cut waiting times and introduced targets, and that made a difference. It made things better for patients. We will never stop making that case, in the House and outside.

Several hon. Members: rose—

Eleanor Laing: Order. I am afraid that this is rather unfair on those who have waited all day and have not yet spoken, but some Members have taken much more than seven minutes, and I must now reduce the time limit to five minutes.

Jo Churchill: I pay tribute to all who work in our national health service and welcome this important debate. I hear the Secretary of State not blaming, but looking for solutions; that is more what we should be about. I have called for an honest debate about the NHS since I came to this place. The NHS is 70 years old next year, and if it is going to reach 100 we need to look after it.
But I want to start with the positive. My own hospital, West Suffolk, saw a 20% increase between Christmas and new year in the number of patients admitted. Those patients were poorly—very poorly; that point was made earlier. The hospital had prepared a resilience plan for a 5% uplift in patient numbers, but it has coped spectacularly well. To refer to a point made by the hon. Member for Tooting (Dr Allin-Khan), who is no longer present, people come into A&E with ingrowing toenails and dry skin, and it is important that we make sure we see the most poorly people in the most appropriate way and use resources most effectively.
My constituency has the second oldest population in the country. There is an ageing population with comorbidities, and in the next 10 years the number of those aged 85-plus will rise by 45%, so the allocation of resources as we go forward is important.
But my hospital has been one of the most resilient in the east, at 85%, and its resilience is in most part due to its fantastic staff. West Suffolk hospital has been innovative. It pays for 20 beds in Glastonbury court, a facility owned by Care UK to provide a step-down facility. In January it will be doing a bridging care service with the councils. Improvement will come through prevention and integration, and not always by shouting for more money.
My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) said that what we need is good integration. Good working in Suffolk needs to be copied. As my hon. Friend the Member for Wells (James Heappey) and the hon. Member for Central Ayrshire (Dr Whitford) said, STPs need to be looked at as a force for good, and I urge Labour not to knock them, but to work with them. They are clinician-led, which is what everybody was asking for.
We cannot have everything we want in life—we never can—and we cannot have everything we want out of the NHS. That is why we need an honest conversation. With rising expectations and an ageing population, the private sector has been in use in the NHS since 1948. If we are going to get more bang for our buck, we should perhaps look at parts of the private sector in order to be able to enhance what we give patients through these critical periods.

Simon Hoare: My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

Eleanor Laing: Thank you. Jo Churchill.

Jo Churchill: I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.
If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally in order to enhance the patient experience.
We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. The right hon. Member for North Norfolk (Norman Lamb) has championed that, and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.
We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system in order to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

Margaret Greenwood: The fact that an organisation as highly respected as the Red Cross should describe our NHS as facing a “humanitarian crisis” is absolutely shocking. It goes to the heart of this Government’s failure to provide a reliable, properly resourced national health service free at the point of need. That should be a source of shame for the Government. Reports last week that two patients died on trolleys in corridors—one having waited 35 hours to be seen—are truly shocking. Can this really be the face of the NHS in England in 2017? Under the Tories, it seems that it is. The Health Secretary responded by suggesting that the four-hour target should apply only to the most urgent cases, and that it was estimated that 30% of patients in A&E did not really need to be there. In other words, he blamed patients and suggested a downgrade of A&E services. He should hang his head in shame.
It is this Tory Government who have decided to cut funding to the health service, asking it to make savings of £22 billion. In Cheshire and Merseyside, the NHS has to find savings of £l billion. Wirral clinical commissioning group calculates that it will have a £12 million deficit for the year 2015-16, nearly a third higher than the original £9 million forecast, but NHS England has asked it to maintain the forecast at £9 million. I would be interested to hear why this curious request has been made. Patients in Wirral West are concerned about the impact that these savings—or cuts—will have at Arrowe Park hospital and in general practice, and they are right to be concerned. The biggest financial squeeze in the history of the NHS is putting services at risk.
Let us be clear: there is nothing inevitable about these Tory cuts. This is a political decision and it is being used to drive through changes including the introduction of accountable care organisations, borrowing a model from America where such organisations are used to deliver private insurance-based healthcare. An NHS manager from my constituency has written to me saying:
“The STPs and national policy are currently pushing for a redesign of services—primary care at scale and a move to make system-wide organisations. The real punch line is there is no   funding to make these changes. Locally there is talk about an Accountable Care Organisation for Wirral—meetings of senior managers across health and social care are being held on almost a weekly basis to create a roadmap for this to happen. With no money with which to do it. Having fragmented services and finally recognised the failure and destruction caused by the faux ‘internal market’ in the NHS, they are now making services use what pitiful resources they have to try and put it all back together. I truly despair that there will not be an NHS this time next year.”
That is a stark warning and a damning indictment of the Government’s failure. The Secretary of State should be addressing the crisis by giving the NHS and social care the funding they need, to make up for this crisis of the Government’s own making around access to GP appointments, a failure to train enough nursing staff, a failure to fund social care, and cuts to community pharmacies when communities need them most.
I have long been aware of the Tories’ agenda for the national health service. The Health and Social Care Act 2012 opened it up to the private sector so that profit-hungry companies can cherry-pick the work that they want to deliver and allowed NHS hospitals to give half their beds to private patients. I believe that this Government and previous Tory Governments are seeking to move us to a two-tier system in which those who can afford to do so have private health insurance and the rest are left with a bargain-basement NHS. The arc of NHS history during the Tories’ time in office since the Thatcher period shows this, and we now appear to be reaching the end game.
The Government are cutting the supply of healthcare in the public sector to create demand in the private sector. The Secretary of State may believe in an ideological drive to introduce a system in which the individual pays their own way through individual private insurance—he is of course entitled to that view—but that is an entirely different concept from a national health service, of which Labour Members are so proud. He must be honest about that. In the process of trying to transfer us to a two-tier, insurance-based model, did he not pause to think about the human suffering he would unleash in the process? Patients wait for hours on trolleys while anxious relatives watch on helplessly, and dedicated staff are stressed out day after day.
Now is the time for a decision. It is not too late for the Government to review their approach. They can face the facts and admit to themselves that English people want a state-managed, state-funded national health service that is free at the point of use and paid for through direct taxation—just like the one created after the second world war by a Labour Government with such vision and which became the envy of the world. The Government should swallow their ideological pride and say, “Okay, we get it. We will fund the national health service.” Anything less will be a betrayal of all that the NHS stands for.

Huw Merriman: We need to look afresh at the entire health and social care pathway, which is why I am delighted to be able to contribute today. From visiting the pharmacist, to attending a GP appointment, to spending time in hospital, whether planned or through A&E, to being able to reside beforehand and afterwards at home or in a care home, we need to find the most efficient and dignified way to treat and look after people. We must avoid using one treatment  centre as a default option—that is not the best option either for the individual or for the public purse—because it is the only one available owing to difficulties with individual funding pots, opening hours or lack of access to better forms of provision. We must also be encouraged to speak freely about the pressures in the system and to provide ideas. It has frustrated me for years that anyone who thinks aloud about ideas that could change health and social care for the better is denigrated as seeking to harm it when the opposite is true.
To that end, I listened with interest to the Secretary of State’s interview on Radio 4 on Monday morning. It struck me as measured and thoughtful about new ideas. I was particularly interested in the suggestion as to how we could deliver more capacity in the GP system, because an increasing number of people attending A&E are neither accident victims nor in need of emergency treatment; they do, however, need some form of medical intervention, as the Secretary of State mentioned. It was then thoroughly depressing to read the Secretary of State’s words taken out of context. I hope that he will continue to think outside the box and that all Members will recognise the benefits of his so doing.
Speaking of ideas, I have the following suggestions for each of the treatment centres in the health pathway, starting with pharmacies. In the event that we have too many pharmacy clusters, I completely agree with the need to ensure that they are spread out across the country with the money saved being recycled. At the same time, we should find ways to help pharmacies deliver more interventions in order to free up capacity at GP surgeries. We must do more to signpost patients to pharmacies before they go to their GP. A recent report costed common ailment treatment in community pharmacies at £29 a patient. The cost rises to £82 for GP practices and to £147 for A&E. Treatment results across all three were equally good. The research estimated that 5% of GP consultations for common ailments could be managed by community pharmacies, equating to more than 18 million GP consultations that could be diverted.
I was buoyed by the Secretary of State’s suggestion that more GPs should be placed in A&E departments and in care homes. The new NHS pilot requiring GPs to undertake weekly ward rounds in care homes is the right type of thinking to prevent emergency treatment in our hospitals. I welcome GP surgeries opening on Sundays, but surely only one surgery in each area needs to be open. I do not believe that having all GP surgeries open seven days a week is a good use of scarce resources, in the same way that Government funding of two pharmacies across the road from each other is not a good use of such resources.
Finally, I have long taken the view that we need to find ways to free up our GPs’ time so that they can focus on the patients who need them most. There are too many wasted or cancelled appointments because the service is free. If there was a cost to unjustifiably failing to keep an appointment, it may demonstrate how precious this resource is—just as NHS dentists would charge for a missed appointment when I was younger.
Some of the reforms of pharmacies and GPs are designed to ensure that patients only attend A&E if they have had an accident or in an emergency, which is clearly not the case for some who are now attending. We are also facing demand for hospital places because of a need to reform the way we look after an ageing population.
Time does not allow me to talk about social care, which is so important in my constituency, but the Government’s delivery of more social care funding before Christmas is welcome. However, it is crucial that we question the operating model in social care. The NHS benefits from a national funding programme, but social care is largely the responsibility of local authorities and local rate payers in areas where retirement rates may be high but employment and council tax receipts are not. We have to think radically to ensure that we get the best out of our health and social care system. To do so will not only make resources stretch further but will deliver innovation that improves the lives of the sick and infirm, who are most in need of our care.

Liz McInnes: Two days ago, the Health Secretary read out a statement in this Chamber on the crisis in our NHS. His answer to his Government’s failure to meet A&E waiting time targets is to downgrade those targets rather than seeking to take any action to treat the malaise at the heart of our NHS.
The Health Secretary heaped praise on our hard-working and dedicated NHS staff—praise they richly deserve—but it will ring hollow with many of them. I speak from years of experience working in the NHS as a clinical scientist with staff of all grades, skills and experience. The simple truth is that NHS staff are demoralised, and, as I said two days ago, they continue to work with care and compassion in spite of, not because of, his action.
Since that statement, I have been inundated by NHS staff wanting to tell me their stories: of how the service they were once proud to work in is now in perpetual crisis; of the strain of wanting to do their best for their patients but being prevented from doing so because of short staffing, overcrowding, delayed discharges and underfunding; of the emails they get from Ministers demanding to know what they will do about the failure to meet targets; and of their listening to the same Ministers telling the public that the NHS does not have a problem.
Health managers are saying that we have a perfect storm of ageing patients who need more care just at the time when social care has been cut to the bone, leaving hospitals to pick up the pieces. An A&E doctor at Manchester Royal infirmary told me:
“Crisis is the new normal”.
The doctor said that it has become usual to have 10 patients waiting in a corridor.
In my constituency of Heywood and Middleton, the Pennine Acute Hospitals NHS Trust has just been the subject of a damning report revealing appalling neglect in maternity care that led to the avoidable deaths of mothers and babies. The trust had the most 12-hour A&E waits in October and the second most cancelled urgent operations in November. In December it was forced to divert ambulances 14 times in total, one of the highest figures in the country.
Social care across Greater Manchester faces collapse. That is borne out by the delayed discharge figures for Greater Manchester, which doubled in the year to October. Greater Manchester asked for £200 million for social care in the autumn statement, but the issue was not even mentioned. Some see Greater Manchester’s devolved  healthcare system as a solution, but even its chief officer, Jon Rouse, says that although devolution can help closer working it is not “magic dust”.
I remind the Health Secretary of the NHS constitution for England, which was updated in October 2015 and establishes the principles and values of the NHS in England. It sets out rights to which patients, the public and staff are entitled, and it sets out pledges that the NHS has committed to achieve. Enshrined in the constitution is the patient’s right to be cared for in a clean, safe, secure and suitable environment and their right to be protected from abuse and neglect—in other words, not to have to wait in an A&E corridor.
Patients and the public have the right to be involved in the planning of healthcare services, in changes to the way that healthcare services are provided and in decisions affecting the operation of those services. For NHS staff, one of the pledges is to engage staff in decisions that affect them and the services they provide, yet I see precious little evidence of staff, patients or the public having any input into the 44 STPs covering the regions of England, which appear to have been drawn up behind closed doors and are shrouded in secrecy. Their impact on healthcare in our regions could be huge, but where is the public involvement?
Patients are being failed on this Government’s watch and their rights to safe care are being neglected. All the Health Secretary has for NHS staff is the occasional flurry of warm words, yet the war he waged over the junior doctors’ contract showed his real attitude towards NHS staff. Nye Bevan said:
“no government that attempts to destroy the Health Service can hope to command the support of the British people.”
That is from Bevan’s book of essays “In place of Fear”. Sadly, the current Health Secretary has managed to achieve “replacing the fear”.

Barbara Keeley: I want to start by paying tribute to our hard-working staff in the NHS and those in the care sector. The best way to thank those staff would be by giving them the resources they need to do the job we want them to do.
I welcome the contributions made by hon. Members today, particularly the moving contribution from my hon. Friend the Member for Chesterfield (Toby Perkins), who bravely told us about the personal catastrophe for him and his family when his father was sent home from a pressured A&E, sadly to die from an aneurysm. My hon. Friend the Member for Workington (Sue Hayman) was able to tell us about the happy death her father had with the end-of-life care at the local community hospital.
The hon. Members for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston) both emphasised the complexity and frailty of patients needing care in the winter months. We should remember that in terms of the scale of pressures facing the NHS. Both those Members supported the four-hour target for A&E as a barometer of the wider system pressures in the NHS: a measure of how the system is managing to process those frail and complex patients. My right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), as a former Minister for emergency care, urged the Government not to give the NHS the impression  of giving up on the four-hour target, as that sends the wrong message. At our NHS leaders’ summit yesterday, we heard a real concern that, for instance, parents might be discouraged from taking their children to A&E.
Conservative Members have cited both Simon Stevens and Chris Hopson in support of their claims on NHS funding, but I would like to update them, because in the House this afternoon Simon Stevens said that
“we got less than we asked for”
and that the Government are
“stretching it to say the NHS…got more”.
He also said that it does not help anybody to pretend there are not financial gaps. Chris Hopson, of NHS Providers, said:
“No, we don’t believe the NHS has got all the money it needs”
and that the NHS is not sustainable on current funding.
I turn now to the pressures on the NHS caused by social care. The crisis in our hospitals has been made much worse by the Government’s continued failure to fund social care properly. The care crisis is caused by insufficient funding in the face of growing demand, and Ministers have ignored warnings from a wide group of doctors, and from leaders and professionals in the health and care sectors. The Government failed to produce a single penny of extra funding for social care in the autumn settlement. Then they told us that extra funding was being made available for social care in the local government funding settlement, but this was not the extra funding so desperately needed from central Government—what Ministers did was to shift the burden on to council tax payers. That was made worse by the fact that the £240 million adult social care grant was actually money recycled within local government budgets, from the new homes bonus. One third of councils will be worse off as a result of this settlement; my own local authority, Salford, will have £2.3 million less in its budgets. This is not a boost to social care.
What health and social care leaders had pleaded for was for Ministers to bring forward funding promised for 2019 to address the current crisis in social care, and that is what today’s motion proposes. That would provide some breathing space, which is needed because the lack of social care means that thousands of older people are stuck in hospital waiting for a care package in their own home. That was the most common cause of delayed discharges caused by social care. More than a third of the record 200,000 delayed days most recently reported were due to lack of social care. Being stuck in hospital not only affects patient morale and mobility; it increases the risk of the patient getting hospital-acquired infections. The major impact, though, is the knock-on effect on people in A&E who are waiting for a bed for an emergency admission.
Health Ministers like to blame local authorities for the lack of social care, but there are problems with that. When NHS chief executive Simon Stevens gave evidence to the Communities and Local Government Committee’s recent inquiry into social care, he was asked by the Chair, my hon. Friend the Member for Sheffield South East (Mr Betts), what extra resources would be needed if every local authority performed as well on delayed discharge as the best local authority. He said:
“Even having sorted that out, if we have a widening gap between the availability of social care and the rising number of frail old people, that is going to show up as extra pressure on them, their families, carers and of course the NHS.”
Of course we want to reach a position where the best practice in tackling delays is spread throughout the country, but Ministers have to start to reflect on what their Government have done through the cuts they have inflicted on local authority budgets. Figures from the Local Government Association show that the hardest hit local authority has had cuts to its budget of 53% over the past five years; the average cut is 39%.
The budget cut for Surrey was at the lower end of the scale, at 29%. Even so, the cabinet member for social care in Surrey, Councillor Mel Few, wrote a letter to The Guardian about the issues faced by his local authority. He said:
“The Care Quality Commission is not the only organisation with worries about inadequate adult social care funding and the impact on already clogged-up hospitals.”
He went on to say that although the social care precept was
“a welcome move, it falls many millions of pounds short of what is needed now—let alone in two decades.”
I suggest that the Health Secretary and the Chancellor talk to social care leaders such as Councillor Few to understand the needs that they see in local communities and the impact of the lack of social care on NHS hospitals. Ministers have been warned and warned about the impact of cuts on social care, but they have ignored those warnings. The Royal College of Emergency Medicine has said that emergency care is
“on its knees…mainly due to a lack of investment in both social and acute health care beds”.

Nicholas Soames: Will the hon. Lady give way on that point?

Barbara Keeley: No, I will not.
The BBC has reported that last week there were 18,000 trolley waits—that is, people waiting on a trolley in a hospital corridor—of more than four hours, and there were 485 cases of patients waiting more than 12 hours. My hon. Friend the Member for Preston (Mr Hendrick) rightly said that we do not even know the figures for patients waiting in corridors, or being treated and waiting on a chair because of a lack of trolleys.
The figures do not tell us about the misery for patients and their family members waiting with them. Last night, a senior A&E consultant said on “ITV News” that patients can be left with absolutely no dignity during these waits. He said:
“We have got patients with severe illnesses on chairs receiving drips, antibiotics, medications, and patients with cardiac problems on chairs because there are no trolleys for them to go on to.”
The senior doctor talked about patients who were left unable to move off their trolleys or who were stuck on chairs, and about a lack of shutters and blinds, meaning that patients can be left in full view of others while they are being treated. He also reported that some patients were incontinent in front of relatives and strangers because hospital staff could not reach them in time. He said:
“Patients have absolutely no dignity left.”
That is what the lack of social care and acute beds can lead to. How would any of us feel if that was our relative?
The situation may get worse with the expected cold weather, when more major incidents may be declared and more hospitals are put on black alert—the most severe warning level, which means that they cannot cope with the number of patients.
Downgrading the four-hour waiting time target for A&E misses the point that the problems in emergency departments are a symptom of a much wider problem. As has been discussed in the debate, that four-hour target is a proxy for patient safety. It is miserable for a sick patient to lose their dignity through being incontinent during a trolley wait in a hospital corridor. It is also miserable and frightening for a vulnerable patient to be discharged in the middle of the night to a cold home with no care package. That is why we repeat in the motion our call for the Government to bring forward £700 million of the funding promised to social care in 2019 to help the NHS and social care systems to cope with the extra pressures this winter. We are also calling for a new, improved settlement for the NHS and social care to be included in the Budget in March, so that we avoid this sort of crisis in future.
Staff in emergency departments are at the sharp end of saving lives. Many other NHS staff save lives, too, but A&E staff are so directly on the frontline. Whether they are working in people’s homes or in care or nursing homes, care staff make a huge difference to the lives of millions of older and vulnerable people, people with disabilities and people with mental health conditions. Those should be the best jobs in the UK, but without the right investment in the funding they need, the people doing them feel undervalued and overstretched. I urge Members to vote for the motion tonight.

Philip Dunne: I am pleased to follow the hon. Member for Worsley and Eccles South (Barbara Keeley) and to be able to close this debate. I thank all 34 hon. Members for their contributions, some of whom—mostly those on the Government Benches—managed to rise above party politics and make some constructive comments.
I join my right hon. Friend the Secretary of State in thanking the 2.7 million staff working in our NHS and social care system. As the Prime Minister said earlier, we recognise that they have never worked harder to keep patients safe, with A&Es across the country seeing a record number of patients within four hours in one day last month.
Regrettably, after five and a half hours of debate and criticism from Labour Members, we have heard little, if anything, about how to provide solutions to the challenges that our A&Es face.
Once again, the Opposition have touted more funding as their only answer to solve public sector challenges. In fact, they have pledged to raise corporation tax eight times, promising an unspecified amount from an unspecified source. That will not help our NHS and it will not fool the public. There is much to do to protect the system and ensure a sustainable future, but it is this Government who have plans in place to get through this extremely challenging period and sustain the NHS for the future.
The shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), spoke for about three quarters of an hour without making a single suggestion about how to solve the problems that face  the NHS—not one. He should have stayed to listen—he may have done and I apologise if I did not pay enough attention to his presence in the Chamber.
The former Health Minister, the right hon. Member for Doncaster Central (Dame Rosie Winterton), asked specifically for community pharmacists to be paid for providing minor ailments services. I am pleased to be able to tell her that that is precisely what we are doing. The Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), was discussing that only this morning in Westminster Hall, and I regret to say that not a single Labour Member was present to hear what he had to say. [Interruption.]

Eleanor Laing: Order. Surely the House wants to hear the Minister after this long debate—with courtesy.

Philip Dunne: We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to the hon. Member for Chesterfield (Toby Perkins), who is in his place, and the hon. Member for Workington (Sue Hayman), both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.
I congratulate my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.
The Opposition sought to take the moral high ground in this debate. The hon. Member for Dewsbury (Paula Sherriff) challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend the Member for Lewes (Maria Caulfield) who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.
There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend the Member for Chelmsford (Sir Simon Burns) for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend the Member for Crawley (Henry Smith), who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend the Member for Forest of Dean (Mr Harper) for another thoughtful contribution from the Back Benches.
Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.

Luciana Berger: Will the Minister give way?

Philip Dunne: I will not give way. The hon. Lady did not give way and I have a very short time left in which to speak.
Compared to when the Conservative party came into office in May 2010, in 2015-16 there were 2.4 million more A&E attendances. That is in the context of a much busier NHS overall. The NHS is delivering 5.9 million more diagnostic tests. Some 822,000 more people are seen by a specialist for suspected cancer and 49,000 more patients start treatment for cancer every year compared with the year before we came to office. It is therefore the case that a Government of any colour would be faced with the same problems, but it is this Government who have committed to funding the NHS’s own plan for a sustainable future. Had we followed Labour’s plans, the NHS would have £1.3 billion a year less, which is equivalent to 13,000 fewer doctors or 30,000 fewer nurses.
We remain committed to the vital four-hour A&E promise for those patients who need to be there. We are proud to be the only country in the world to commit to all patients that we will sort out any urgent health need within four hours. Only three other countries—New Zealand, Australia and Canada—have similar national standards, but none of those is as stringent as ours.
Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour did and why we are delivering more funding with a higher proportion of total Government spending going into health in each year since 2010. Funding for the NHS will rise in real terms by £10 billion by 2020-21 compared with 2014-15. That sum is front-loaded with £6 billion being delivered by the end of this year, as the NHS asked for. It was this Government who established an independent NHS with an independent chief executive. It was this NHS that came up with its own plan and we were the only party to back it. We agree that the NHS and social care face huge pressure and, yes, there is more for us as a Government to do. However, we entered winter with a more comprehensive plan than ever before, and we have confidence that plans are in place to cope with the current pressures we face—winter, A&E and delayed discharges—and to sustain the system for the future.
I conclude by saying a huge thank you to the 1.3 million staff in the NHS and the 1.4 million people who provide social care. They are the ones who continue to make this possible. We are aware of the pressures they are under, especially during winter. We have increased the number of doctors and nurses, as the Secretary of State said earlier, especially in A&E, and we have launched plans to recruit more doctors and nurses. Without them, we would not have a national health service that provides such a high level of care.

Nick Brown: claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.
The House divided:
Ayes 209, Noes 295.

Question accordingly negatived.
Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.
Question agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No. 31(2)).
Resolved,
That this House commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours;  welcomes the Government’s support for the Five Year Forward View, the NHS’s own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.

Margaret Greenwood: On a point of order, Madam Deputy Speaker—[Interruption.]

Eleanor Laing: Order. If Members wish to have conversations, they should go somewhere else. The hon. Lady is making a point of order.

Margaret Greenwood: The Minister told the House that there were no Labour Back Benchers in this morning’s debate on community pharmacies. In fact, he has inadvertently misled the House in that regard, because I was in Westminster Hall and I spoke in the debate, as was my hon. Friend the Member for Sefton Central (Bill Esterson), who also spoke in the debate. I just wanted to put the record straight.

Eleanor Laing: I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.

Philip Dunne: rose—

Eleanor Laing: It looks as though the Minister would like to say something further to that point of order.

Philip Dunne: Further to that point of order, Madam Deputy Speaker. To give the House complete clarity, I understand that two Labour Back Benchers were present and made minor interventions in the Westminster Hall debate, but there were no speeches or substantive contributions by those Labour Members.

Eleanor Laing: I am sure that the House is grateful to the Minister for clarifying what he said in his speech, and to the hon. Lady for clarifying the position. The matter is now closed.

BUSINESS WITHOUT DEBATE

DELEGATED LEGISLATION

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Local Government

That the draft Combined Authorities (Mayoral Elections) Order 2017, which was laid before this House on 28 November, be approved.—(Christopher Pincher.)
The Deputy Speaker’s opinion as to the decision of the Question being challenged, the Division was deferred until Wednesday 18 January (Standing Order No. 41A).
Motion made, and Question put forthwith (Standing Order No. 118(6)),
That the draft Combined Authorities (Mayors) (Filling of Vacancies) Order 2017, which was laid before this House on 28 November, be approved.—(Christopher Pincher.)
Question agreed to.

Mary Creagh: I rise to present a petition of 2,000 residents of Wakefield on the future of the King Street health centre in my constituency, whose GP service is under threat of being withdrawn—a very important issue for my constituents.
The petition states that the petitioners
request the House of Commons to urge the Government and Wakefield Clinical Commissioning Group to take all necessary steps to ensure that King Street Health Centre remains open and has the current contract for GP-led services extended to allow Wakefield residents continued access to health care.
Following is the full text of the petition:
[The petition of residents of Wakefield,
Declares that King Street Health Centre is a vital service for Wakefield, and helps to ease the pressures on local GP surgeries, pharmacies, and Pinderfields Hospital; further that Wakefield Clinical Commissioning Group is reviewing the future of the GP-led services at King Street Health Centre, as the contract is up for renewal in March 2017; further that the petitioners are concerned that closure or removal of services from King Street Health Centre would put at risk the future of the King Street Walk-in Service, which shares the same facilities, staff and building; and further that 1955 persons have signed an online petition in similar terms.
The petitioners therefore request the House of Commons to urge the Government and Wakefield Clinical Commissioning Group to take all necessary steps to ensure that King Street Health Centre remains open and has the current contract for GP-led services extended to allow Wakefield residents continued access to health care.
And the petitioners remain, etc.]
[P002001]

PETITION - BOAT MOORINGS ON THE RIVER AVON

Jacob Rees-Mogg: My petition comes from dozens of residents of Saltford in Somerset.
The petition states:
The Humble Petition of residents of Saltford,
Sheweth,
That the petitioners would prefer the inhabitants of some boats moored on the River Avon in Mead Lane to refrain from staying for long periods of time.
Wherefore your Petitioners pray that your Honourable House ask Her Majesty’s Government to consider the opinions of local residents and other boat owners in this regard.
And your Petitioners, as in duty bound, will ever pray, &c.
[P002002]

A&E Provision: Shropshire and Mid-Wales

Motion made, and Question proposed, That this House do now adjourn.—(Christopher Pincher.)

Daniel Kawczynski: In the previous Parliament, we took action to empower local doctors, surgeons and clinicians to think about the optimum way of providing hospital services under ever-changing circumstances, namely the demographic and other changes that are taking place in our society. That was the right step to take. Rather than remote civil servants in Whitehall making those decisions, we wanted to ensure that the people at the coalface provided those services—people who already provide services to our constituents; people with medical expertise; people who have dedicated their lives to improving the care and safety of others. We wanted to empower them to make those decisions.
I stand by the decision that we took, but I want to tell the Minister this evening about some of the practical problems that have ensued in Shropshire as a result of that devolution of power. I do so because I believe in the process and want to ensure that it is retained and protected for future programmes.
We have two hospitals in Shropshire: one in Shrewsbury and one in Telford. They do not just look after the people in those two towns; they look after all the people throughout the whole of Shropshire and mid-Wales. I am not going to go into all the specifics of the Future Fit programme with the Minister, as I and the other Shropshire MPs have briefed him repeatedly about the process over the past few days, weeks and months. However, I would like to thank, in a genuine and heartfelt way, the 300 surgeons, doctors, GPs and medical consultants in our community in Shropshire, who, despite the extraordinary pressures they face already in their day-to-day work in the NHS, have been able to dedicate themselves to and persevere with, despite the many problems and obstacles in their way, coming up with the Future Fit proposals for a reconfiguration of accident and emergency services in Shropshire and mid-Wales. A decision has been achieved after three years and £3 million of taxpayers’ money.
There was going to be a public consultation on that decision. Unfortunately, it has been blocked by Telford clinical commissioning group and Telford Council. Telford CCG has been a part of the process from its inception and it was consulted throughout. At the eleventh hour, however, when the decision did not go the way it thought it would or the way it wanted it to go, it decided, to a man, to vote against the proposals—even though it was party to the whole methodology and process.
In addition to Telford CCG voting against the changes, Telford Council—an esteemed body no doubt, but one, I would argue, with somewhat limited medical experience—has decided to threaten the Future Fit programme with a judicial review if the public are allowed to have the final public consultation. Of course, in a democracy Telford Council has the right to challenge things. Of course, in a democracy Telford Council may even have the right to use taxpayers’ money to instigate a judicial review. What the Minister must remember and retain from our experience, however, is that these two parties were a part and parcel of the whole process from its  inception. I have a real and genuine concern about the integrity of the process if we do not back the local clinicians and doctors.

Lucy Allan: Will my hon. Friend give way?

Daniel Kawczynski: I will of course give way to my hard-working neighbour from Telford.

Lucy Allan: I thank my hon. Friend for securing this debate. I tried to secure a debate with a very similar title. Does he agree that the Telford clinicians have an absolute right to express their views, just as the Shropshire clinicians do? The fact that they did not come to the same view is no indication that the Shropshire clinicians came to the wrong view.

Daniel Kawczynski: As I said earlier, of course they have the right to do so. Let me take this opportunity to acknowledge the work my hon. Friend has done since she became a Member of Parliament to campaign for Telford, and to campaign very strongly and effectively on this issue without being overtly political or personal, unlike some other people. I will come on to talk about the CCG a little later.
I reiterate that my concern is for us all to put our cards on the table. We all went along with the Future Fit process. The decision could have gone against Shrewsbury. Ultimately, the decision has been made to have the urgent care centre in Telford and that the main A&E service should be provided by Shrewsbury. That decision could have gone the other way. It could have gone to Telford, and we would have lost out. At the end of the day, it should not be about winning or losing—that is the biggest problem.
My right hon. Friend the Member for North Shropshire (Mr Paterson) has talked about the pillow fight that has gone on between Shrewsbury and Telford ever since he became an MP. Over the past 11 years, I have lost more sleepless nights over the constant fighting between Shrewsbury and Telford about hospital services than over anything else. At the end of the day, we are one county and we must fight collectively as one county for all the people of Shropshire, and of course for our friends across the border in Wales.

Owen Paterson: I congratulate my hon. Friend on landing this debate. He is absolutely right. This bickering between Shrewsbury and Telford has dogged my nearly 20 years in Parliament. I thoroughly back Future Fit because it provides a solution that benefits everybody. I like the idea that the two existing A&Es carry on doing 80% of their current work, albeit—possibly—having been renamed as urgent care centres, while we get a £300 million emergency care centre. Some of my rural areas look to Shrewsbury, some look to Telford, but we will also gain from urgent care centres being built in the rural areas. What is utterly exasperating for my constituents is this indecision. We have had three years and £3 million spent, and still no decision. I am delighted that the Minister is listening so carefully and I very much hope that at the end of the debate we will have a clear recommendation for a decisive mechanism to deliver the will of the local commissions.

Daniel Kawczynski: I could not agree with my right hon. Friend more, and I pay tribute to him for the work he has done on this over the last few years.
I would like the Minister to intervene to ensure that the process allows for a decision. In our case, all six members of the Shropshire CCG voted for the proposals and all six members in Telford voted against. I am very concerned—I want him to take this away—about this. What sort of a process is it when we can get a tie? There needs to be a casting vote or perhaps some independent third party who can arbitrate in such a hotly contested issue where the two local CCGs cannot come to an agreement. So I would like to hear from him on that.
I appeal to constituents from the whole of Shropshire and mid Wales to lobby Telford Council, to get behind the concept of us all working together, as my right hon. Friend said, and to lobby the Government more effectively for more resources, rather than fighting one another in a rather parochial way over where these services are going to be. Let us not forget how close these two hospitals are to one another. We are not talking about 50 miles, 30 miles or 20 miles. Somebody might correct me if I am wrong, but I think they are only 13 miles apart. We ought to be thinking about how to improve and modernise the provision of healthcare for all the people of Shropshire and mid Wales and listening to the proposals of the medical experts, who have done so much work to put these proposals together.

Chris Davies: I thank my hon. Friend for bringing this debate forward. Both my hon. Friend the Member for Montgomeryshire (Glyn Davies) and I represent seats in Powys, in mid Wales, which, as he said, does not have a general hospital. It is one of the few councils not to have one. We rely heavily on both Telford and Shrewsbury, certainly in the top end of my constituency. I appeal to the Minister: our constituents are very concerned. Even though health is devolved in Wales, many of our constituents travel across the border, and for them this is a vital issue.

Daniel Kawczynski: I thank my hon. Friend for his intervention. He is absolutely right. In fact, my colleague from just across the border, my hon. Friend the Member for Montgomeryshire (Glyn Davies), always joins us at our meetings with our hospital trust. We almost think of him as a Salopian. [Hon. Members: “Steady!”] Not quite, but he does so much to represent his constituents in Wales, who already have to travel long distances to get to the Royal Shrewsbury hospital. He might correct me if I am wrong, but I think that some of them, from the extreme west of his constituency, already have to travel for over an hour to access A&E services in Shrewsbury. So any movement even further away from Shrewsbury would be completely unacceptable to his constituents.

Mark Williams: I come from a peripheral position, further to the west of Montgomeryshire. I congratulate the hon. Gentleman on securing this debate, and stress the importance of getting this right, because it has an impact further to the west. If this issue is not resolved, it will impact on the capacity of my district general hospital in Aberystwyth to serve the people of mid-Wales as well. It is crucial to address this issue.

Daniel Kawczynski: I concur with the hon. Gentleman, and I am grateful for his intervention.
I shall start to end because I want to give the Minister as much time as possible to answer these questions. Let us not forget that if we get this right, it could result in an investment of £300 million into the NHS in Shropshire. I do not know about all my colleagues—I know that my right hon. Friend the Member for North Shropshire has been an MP for longer than me—but I certainly do not remember a time during my 11 years as an MP when we have had such an investment in the local NHS. As I say, if we get this right, we could see an investment of £300 million in Shropshire in order to implement these changes.
I know that there is more work to be done to secure this money. I know that more work will have to be done in innovative ways, both locally and nationally, in order to secure all the funding. If we do not sort ourselves out, however, we are going to get further and further behind, while other areas in the United Kingdom—this is not an issue peculiar to Shropshire—that are going through this process in a more cordial and mutually effective way are going to jump the queue, and Shropshire will be left right at the end. I am not prepared to see that happen.
Finally, Telford Council would obviously have us believe that as part of this programme, women and children’s services have to be moved from Telford to Shrewsbury, because the main A&E will need to have women’s and children’s services next to the main A&E provider at the Royal Shrewsbury hospital. The council says—this is an important point that I want the Minister to note—that because these services were moved from Shrewsbury to Telford a few years ago, such a move would lead to the waste of £28 million. It repeatedly talks about this through the local media. No, no, no. It is not a waste. The building will be used for other purposes, and all the equipment in it, which is easily moved, will be moved to Royal Shrewsbury hospital. So I refute any proposal that there has been a waste of the £28 million invested in women’s and children’s services because of the changes that will take place.

Lucy Allan: I thank my hon. Friend for giving way on that incredibly important point. Will he accept that the brand-new women and children’s unit in Telford has been there only since 2015 when it was opened, and that the proposal to close it is of huge concern to all my constituents? I am sure he will understand why that is.

Daniel Kawczynski: I do understand that concern, and the previous chief executive of the trust responsible for those changes is, I believe, now working in Qatar. It caused a great deal of controversy at the time. Of course, the Government, Ministers and Future Fit will have to do more to alleviate those concerns, but at the end of the day, as my right hon. Friend the Member for North Shropshire has stated, a decision has to be made.
With that, I end my speech and thank you, Madam Deputy Speaker.

Glyn Davies: Thank you, Madam Deputy Speaker, for calling me to speak on what is the most important and concerning issue in my constituency over recent years—and it is certainly particularly acute at this moment. I would love to make  several points and make a full speech at some stage, but on this occasion, I shall restrict myself to making just three points that I hope the Minister will address.
First, I emphasise the importance of the title chosen for the debate: A&E Provision: Shropshire and Mid-Wales. We so often assume that health is devolved, but the reality is that it is a devolved form of government, but it is not independence. The position is that in much of Wales, the system and the financial arrangements between the Governments allow for people to come to Shropshire. Nearly all of Montgomeryshire’s patients who want secondary care, elective care and emergency care go to Shropshire. We depend absolutely on Shropshire, so I am hugely grateful that this debate is about Shropshire and mid-Wales.
My second point concerns the position of A&E units throughout Britain. We know perfectly well what the problem is: too many people are going to A&E without what we think of as reasons to need emergency treatment. We know that about 20% of the people who go to the A&E units in Shropshire should be going to the emergency centre because their conditions are life-threatening, with the remaining 80% going to the two centres in Telford and Shrewsbury. They will still effectively be A&E units, but they may well be referred to as urgent care centres. We know that that system will work.
This is my final point. Our two clinical commissioning groups set up a Future Fit programme board to make recommendations. It spent three years and £2 million—it could have been £3 million—producing a report which made it clear that the emergency centre should be based at Shrewsbury. It was a huge shock to my constituents when that recommendation was not accepted. Everyone is flabbergasted. I merely ask the Minister to give us some idea of how we can move forward from the shambles that is putting the interests and the care of my constituents—who are already having to travel for an hour to Shrewsbury for treatment—at the centre of the plans for Shropshire. That is vital to us. I hope the Minister will tell us how we can provide safe care for the people of Shropshire and the people of mid-Wales, which is our duty.

David Mowat: In the few minutes available I shall give the House a recap, describing the process that we have undergone, the impasse that we have reached, and what it has been suggested we do to bring about a decision. I agree with my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) that it is important for us to make that decision and to get it right. The provision of better A&E services for the whole county in a way that works for everyone should not be the divisive issue that it has become.
First, however, I think it appropriate to reflect on the 2.7 million people who work in the NHS and the care system, and to acknowledge and congratulate them on the work that they do. Today, as every day, some 2 million people have used A&E services across the country. Let me also say that my hon. Friend the Member for Shrewsbury and Atcham has worked diligently on this issue, as have other Members, including my hon.  Friend the Member for Telford (Lucy Allan). I know that it is difficult for them to get this right for their constituents.
At the beginning of his speech, my hon. Friend the Member for Shrewsbury and Atcham made the important point that, ultimately, this must be a local decision. It is not a decision for Ministers, and it will not be imposed. It will be made by the local governance bodies that have been established, notwithstanding the present impasse.
Let me summarise what has been happening. This is a tale of two CCGs and a hospital trust providing services across Shropshire—in Ludlow, Bridgnorth, Oswestry and Shrewsbury—and, indeed, in mid-Wales, including Powys. I agree with my hon. Friend the Member for Montgomeryshire (Glyn Davies) that we need to get this right for the people of Wales as well. The process has been going on for a long time, but the driver for change is not financial. We are finding it increasingly difficult to staff the two A&E centres in Telford and Shrewsbury. Rotas are not being filled, and it is feared that unless we find a robust solution, there will be safety issues and it will not be possible to keep the centres open for as long as we want.
My hon. Friend the Member for Shrewsbury and Atcham observed that this was not a new issue, and that is certainly true. I understand that it is being discussed locally, and that projects have been reviewing it since about 2005 without a solution being found. The Future Fit project was set up in 2013. As has been said, the process ended at the end of last year with a preferred option, which was, in broad terms, that emergency care should be centralised in Shrewsbury, with urgent care continuing to be in both locations. I heard it said in the debate earlier that that would mean most patients would continue to be served closer to where they are, either at Telford or Shrewsbury.
On the governance issue, the report of the Future Fit process was voted on by members of the two CCGs, who have broadly a 50% share in that decision, and the result was a tie. Indeed, Telford CCG raised concerns about the methodology of the process and the appraisal techniques used and whether it was robust and fair. As a consequence, there has been no agreement and we have reached our current impasse.
I understand that at the end of December an editorial in the Shrewsbury Star—

Daniel Kawczynski: Shropshire Star.

David Mowat: Sorry, an editorial in the Shropshire Star—it is not a newspaper I read—made the point that we now need to get this right; we need to make a decision and to stick by it. I think everybody in the Chamber would agree with that, with the caveat that in the end it has to be a local decision. There are very real battle lines here; I think my hon. Friend the Member for Telford met the Secretary of State yesterday on this with other Members and council leaders.
What is the proposed way forward? My briefing from the CCGs is that a week today there will be a meeting at which the intention is that two things happen. The joint committee will be reconstituted and an independent chair appointed who will have a casting vote. In parallel with that, there will be an appraisal, or review of the appraisal process, that Future Fit takes, with the intent to address the concerns raised by Telford about whether  it was robust. At the end of the review—depending on the outcome, I guess—there will be a new vote with a view to potentially having a majority on one side or the other and therefore there will be a local direction. That is my understanding of the way forward.

Owen Paterson: It is tremendous news that there will be a mechanism that will give us the ability to come up with a clear answer. Does the Minister have any idea of the timescale for this new process?

David Mowat: I have been advised that the timescale is in the order of eight to 12 weeks, but it remains a local decision. That is what we hope and expect to be the case.
In finalising my comments, I want to make a couple of observations.

Daniel Kawczynski: I am pleased with the Minister’s announcement; hopefully we will see a conclusion to this. May I appeal to him to take an active interest in the process in these eight to 12 weeks because the integrity of this devolution of power is at stake unless we empower the clinicians to take the decisions we have ultimately empowered them to take?

David Mowat: I am happy to agree to that, although I should have said at the start of my remarks that in the normal course of events this debate would have been answered by my ministerial colleague, my hon. Friend the Member for Ludlow (Mr Dunne), as he is the Minister with this responsibility, although he is not independent on this so it is appropriate that I answer for the Government.
Once the decision has been taken and a consultation occurs, a component of the proposal will require capital. Various numbers have been floated around, one of which is £300 million. I do not believe that NHS England has yet confirmed that that capital is available, so there is a hurdle to be overcome once a local decision has been taken. I do not want to raise expectations that the process will necessarily be straightforward. This is the way in which the process will occur, as I am sure colleagues would expect. If, as a result of that stage, capital is awarded, there is the potential for those on either side of this discussion to take the configuration proposal to the independent reconfiguration panel. That is always the case in processes such as these, and the panel can accept or not accept what has been suggested. That is the normal process in the NHS.
I want to make one final point to all my colleagues, who are so keen to get this right for their constituents in Telford and in Shrewsbury. I ask them to remember that the NHS is not just about bricks and mortar. We often have discussions about the bricks and mortar, but I want gently to point out to right hon. and hon. Members that there are other things that they should be holding their clinical commissioning groups to account for. They should be looking at cancer performance, cancer survival rates and maternity performance, for example. There are many aspects of the NHS that are not about bricks and mortar, and it is important that Members should recognise that when we debate these matters.
Question put and agreed to.
House adjourned.